Published online November 1, 2006
PEDIATRICS Vol. 118 No. 5 November 2006, pp. 1971-1977 (doi:10.1542/peds.2006-1175)
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ARTICLE

Circumcision Status and Risk of Sexually Transmitted Infection in Young Adult Males: An Analysis of a Longitudinal Birth Cohort

David M. Fergusson, PhD, Joseph M. Boden, PhD and L. John Horwood, MSc

Christchurch Health and Development Study, Christchurch School of Medicine and Health Sciences, Christchurch, New Zealand

OBJECTIVES. Previous research suggests that male circumcision may be a protective factor against the acquisition of sexually transmitted infections; however, studies examining this question have produced mixed results. The aim of this study was to examine the association between circumcision status and sexually transmitted infection risk using a longitudinal birth cohort study.

METHODS. Data were gathered as part of the Christchurch Health and Development Study, a 25-year longitudinal study of a birth cohort of New Zealand children. Information was obtained on: (1) the circumcision status of males in the cohort before 15 years old, (2) measures of self-reported sexually transmitted infection from ages 18 to 25 years, and (3) childhood, family, and related covariate factors.

RESULTS. Being uncircumcised had a statistically significant bivariate association with self-reported sexually transmitted infection. Adjustment for potentially confounding factors, including number of sexual partners and unprotected sex, as well as background and family factors related to circumcision, did not reduce the association between circumcision status and reports of sexually transmitted infection. Estimates of the population-attributable risk suggested that universal neonatal circumcision would have reduced rates of sexually transmitted infection in this cohort by 48.2%.

CONCLUSIONS. These findings suggest that uncircumcised males are at greater risk of acquiring sexually transmitted infection than circumcised males. Male circumcision may reduce the risk of sexually transmitted infection acquisition and transmission by up to one half, suggesting substantial benefits accruing from routine neonatal circumcision.

Key Words: circumcision • sexually transmitted infection • males • longitudinal study

Abbreviations: STI—sexually transmitted infection • SES—socioeconomic status • OR—odds ratio • CI—confidence interval • PAR—population attributable risk

Accepted Jun 20, 2006.




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P3Rs:

Read all P3Rs

A confounding factor in the Christchurch circumcision studies
Michael Glass
Pediatrics Online, 13 Nov 2006 [Full text]
Christchurch study is discordant with other studies.
Jonathan Sykes
Pediatrics Online, 15 Nov 2006 [Full text]
Christchurch result is anomalous
Hugh P Young
Pediatrics Online, 15 Nov 2006 [Full text]
Surrogate Consent is Inadequate for Non-Therapeutic Excision of Tissue
Robert M Blair
Pediatrics Online, 18 Nov 2006 [Full text]
Responses to Post-Publication Peer Reviews: Circumcision and Sexually Transmitted Infection
David M. Fergusson, et al.
Pediatrics Online, 21 Nov 2006 [Full text]
A failure of the peer-review system
Robert S. Van Howe
Pediatrics Online, 7 Jan 2007 [Full text]