Poverty and InequalitySexual and Reproductive HealthFamily, Maternal & Child HealthMethodology

Male circumcision reduces penile high-risk human papillomavirus viral load in a randomised clinical trial in Rakai, Uganda

TitleMale circumcision reduces penile high-risk human papillomavirus viral load in a randomised clinical trial in Rakai, Uganda
Publication TypeJournal Article
Year of Publication2013
AuthorsWilson, LE, Gravitt, P, Tobian, AAR, Kigozi, G, Serwadda, D, Nalugoda, F, Watya, S, Wawer, MJ, Gray, RH
JournalSexually Transmitted Infections
Date PublishedMay
ISBN Number13684973 (ISSN)
Accession Number23112341
KeywordsAdolescent, Adult, article, circumcision, Circumcision, Male, controlled study, follow up, Genotype, human, Humans, infection control, major clinical study, Male, Middle Aged, Papillomaviridae, papillomavirus infection, Papillomavirus Infections, Penile Diseases, Prevalence, priority journal, randomized controlled trial, Real-Time Polymerase Chain Reaction, Risk Assessment, risk reduction, Sexual and Reproductive Health, Treatment Outcome, Uganda, Viral Load, virus load, virus shedding, Wart virus, Young Adult

Objectives: Male circumcision reduces penile high-risk human papillomavirus (HR-HPV) prevalence in randomised trials. The goal of this study was to examine the effect of circumcision on HPV viral load among HPV-infected men in a randomised trial of male circumcision. Methods: In a randomised trial to assess the efficacy of circumcision on HIV acquisition in Rakai, Uganda, HIV-negative men were randomised to immediate (intervention) or delayed (control) circumcision and followed over 24 months. We performed quantitative-PCR HPV viral load assays on penile swabs which tested positive by Linear Array (LA) for six HR-HPV genotypes and estimated viral load in the remaining types by LA signal strength. Results: At 24 months, circumcision intervention arm men infected with one of the six selected HR-HPV genotypes had a lower viral load and significantly reduced HR-HPV high LA band intensity (PRR=0.61, 95% CI 0.43 to 0.86) compared to infected men in the control arm of the trial. The decreased viral load associated with circumcision was seen among HPV infections acquired after enrolment but not among infections that persisted from trial enrolment to 24 months ( p=0.80). Conclusions: The decreased penile HR-HPV shedding observed among HPV-infected circumcised men may help to explain the protective association observed between circumcision and reduced acquisition of HR-HPV in female partners.