The effects of male circumcision on female partners' genital tract symptoms and vaginal infections in a randomized trial in Rakai, Uganda

Presented at the 15th Conference on Retroviruses and Opportunistic Infections, Boston, MA, Feb. 3-6, 2008.

Received 12 December 2007; received in revised form 5 June 2008; accepted 31 July 2008. published online 03 November 2008.

Objective

The objective of the study was to assess effects of male circumcision on female genital symptoms and vaginal infections.

Study Design

Human immunodeficiency virus (HIV)-negative men enrolled in a trial were randomized to immediate or delayed circumcision (control arm). Genital symptoms, bacterial vaginosis (BV), and trichomonas were assessed in HIV-negative wives of married participants. Adjusted prevalence risk ratios (adjPRR) and 95% confidence intervals (CIs) were assessed by multivariable log-binomial regression, intent-to-treat analyses.

Results

A total of 783 wives of control and 825 wives of intervention arm men were comparable at enrollment. BV at enrollment was higher in control (38.3%) than intervention arm spouses (30.5%, P = .001). At 1 year follow-up, intervention arm wives reported lower rates of genital ulceration (adjPRR, 0.78; 95% CI, 0.63-0.97), but there were no differences in vaginal discharge or dysuria. The risk of trichomonas was reduced in intervention arm wives (adjPRR, 0.52; 95% CI, 0.05-0.98), as were the risks of any BV (adjPRR, 0.60; 95% CI, 0.38-0.94) and severe BV (prevalence risk ratios, 0.39; 95% CI, 0.24-0.64).

Conclusion

Male circumcision reduces the risk of ulceration, trichomonas, and BV in female partners.

Key words: bacterial vaginosis, female genital ulceration, male circumcision, trichomonas, vaginal infections

a Department of Population, Family, and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD

b Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD

c Rakai Health Sciences Program, Entebbe, Uganda

d School of Public Health, Makerere University, Kampala, Uganda

e Department of Urology, Mulago Hospital, Makerere University, Kampala, Uganda

f Faculty of Medicine, Makerere University, Kampala, Uganda

g Bill and Melinda Gates Foundation, Seattle, WA

h Division of AIDS, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD

Reprints: Ronald H. Gray, Robertson Professor of Reproductive Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, E4132, 615 North Wolfe St, Baltimore, MD 21205

Cite this article as: Gray RH, Kigozi G, Serwadda D, et al. The effects of male circumcision on female partners' genital tract symptoms and vaginal infections in a randomized trial in Rakai, Uganda. Am J Obstet Gynecol 2009;200:42.e1-42.e7.

This study was supported in part by Grants (U01 AI11171-01-02) from the National Institutes of Allergy and Infectious Diseases (NIAID), Division of AIDS, National Institutes of Health (NIH), and Grants 2228 and 220062228 from the Bill and Melinda Gates Foundation. The laboratory component was supported in part by the Division of Intramural Research, NIAID, NIH. This publication was supported, in part, by fellowships/grants from the Fogarty International Center/NIH Grant 2 D 43 TW000010-19-AITRP and 5D43TW001508.

PII: S0002-9378(08)00901-0

doi:10.1016/j.ajog.2008.07.069

10 of 47