American Journal of Obstetrics & Gynecology
Volume 200, Issue 1 , Pages 42.e1-42.e7 , January 2009

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.

  • Ronald H. Gray, MD, MSc

      Affiliations

    • Department of Population, Family, and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
    • Corresponding Author InformationReprints: Ronald H. Gray, Robertson Professor of Reproductive Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, E4132, 615 North Wolfe St, Baltimore, MD 21205
    • ,
  • Godfrey Kigozi, MB ChB, MPH

      Affiliations

    • Rakai Health Sciences Program, Entebbe, Uganda
    • ,
  • David Serwadda, MB ChB, MMed, MPH

      Affiliations

    • Rakai Health Sciences Program, Entebbe, Uganda
    • School of Public Health, Makerere University, Kampala, Uganda
    • ,
  • Frederick Makumbi, PhD

      Affiliations

    • Rakai Health Sciences Program, Entebbe, Uganda
    • ,
  • Fred Nalugoda, MHS

      Affiliations

    • Rakai Health Sciences Program, Entebbe, Uganda
    • ,
  • Stephen Watya, MB ChB, MMed

      Affiliations

    • Department of Urology, Mulago Hospital, Makerere University, Kampala, Uganda
    • ,
  • Laurence Moulton, PhD

      Affiliations

    • Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
    • ,
  • Michael Z. Chen, MSc

      Affiliations

    • Department of Population, Family, and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
    • ,
  • Nelson K. Sewankambo, MB ChB, MSc

      Affiliations

    • Rakai Health Sciences Program, Entebbe, Uganda
    • Faculty of Medicine, Makerere University, Kampala, Uganda
    • ,
  • Noah Kiwanuka, MB ChB, MPH

      Affiliations

    • Rakai Health Sciences Program, Entebbe, Uganda
    • School of Public Health, Makerere University, Kampala, Uganda
    • ,
  • Victor Sempijja, BSc

      Affiliations

    • Rakai Health Sciences Program, Entebbe, Uganda
    • ,
  • Tom Lutalo, MSc

      Affiliations

    • Rakai Health Sciences Program, Entebbe, Uganda
    • ,
  • Joseph Kagayii, MB ChB, MPH

      Affiliations

    • Rakai Health Sciences Program, Entebbe, Uganda
    • ,
  • Fred Wabwire-Mangen, MB ChB, PhD

      Affiliations

    • Rakai Health Sciences Program, Entebbe, Uganda
    • School of Public Health, Makerere University, Kampala, Uganda
    • ,
  • Renée Ridzon, MD

      Affiliations

    • Bill and Melinda Gates Foundation, Seattle, WA
    • ,
  • Melanie Bacon, MPH

      Affiliations

    • Division of AIDS, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
    • ,
  • Maria J. Wawer, MD, MHS

      Affiliations

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

Received 12 December 2007 ,Revised 5 June 2008 ,Accepted 31 July 2008.

References 

  1. Gray RH, Kigozi G, Serwadda D, et al. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomized trial. Lancet. 2007;369:657–666
  2. Bailey RC, Moses S, Parker CB, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomized controlled trial. Lancet. 2007;369:643–656
  3. Auvert B, Taljaard D, Lagarde E, Sobngwi-Tambekou J, Sitta R, Puren A. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial. PLoS Med. 2005;2:e298;Erratum in: PLoS Med 2006;3:e298
  4. World Health Organization/United Nations Programme on HIV/AIDS. New Data on male circumcision and HIV prevention: policy and programme implications. Conclusions and recommendations. WHO/UNAIDS Technical Consultation, Montreux, March 6-8, 2007. In: Geneva (Switzerland): World Health Organization/United Nations Programme on HIV/AIDS; 2007;p. 1–19
  5. Reynolds SJ, Shepherd ME, Risbud AR, et al. Male circumcision and risk of HIV-1 and other sexually transmitted infections in India. Lancet. 2004;363:1039–1040
  6. Gray RH, Azire J, Serwadda D, et al. Male circumcision and the risk of sexually transmitted infections and HIV in Rakai, Uganda. AIDS. 2004;18:2428–2430
  7. Bailey RC. Scaling up circumcision programmes: The road from evidence to practice. Prsented as the Plenary Talk, 4th International AIDS Society Conference on HIV Pathogenesis, Sydney, Australia, July 24, 2007.
  8. Gray RH, Wawer M, Serwadda D, et al. Male circumcision and the risks of female HIV and sexually transmitted infections acquisition in Rakai, Uganda. Presented at the 13th CROI Conference on Retroviruses and Opportunistic Infection, Denver CO, 2006.
  9. Zenilman JM, Freisia A, Berger B, McCormack WM. Bacterial vaginosis is not associated with circumcision of the current male partner. Sex Transm Infect. 1999;75:347–348
  10. Schwebke JR, Desmond R. Risk factors for bacterial vaginosis in women at high risk for sexually transmitted diseases. Sex Transm Dis. 2005;32:654–658
  11. Nugent RP, Krohn MA, Hillier SL. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol. 1991;29:297–301
  12. Thoma M, Gray RH. Male circumcision and genital ulcer disease: a meta-analysis. Presented at the 17th International Society for Sexually Transmitted Disease Research, Seattle, 2007 (Abstract 542).
  13. Weiss HA, Thomas SL, Munabi SK, Hayes RJ. Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta-analysis. Sex Transm Infect. 2006;82:101–109
  14. O'Farrell N, Morison L, Moodley P. Association between HIV and subpreputial penile wetness in uncircumcised men in South Africa. J AIDS. 2006;43:69–77
  15. Serwadda D, Gray RH, Sewankambo NK, et al. Human immunodeficiency virus acquisition associated with genital ulcer disease and herpes simplex virus type 2 infection: a nested case-control study in Rakai, Uganda. J Infect Dis. 2003;188:1492–1497
  16. Taha TE, Hoover DR, Dalabetta GA, et al. Bacterial vaginosis and disturbances of vaginal flora: association with increased acquisition of HIV. AIDS. 1998;12:1699–1706
  17. Martin HL, Richardson BA, Nyange PM. Vaginal lactobacilli, microbial flora and risk of human immunodeficiency virus type 1 and sexually transmitted disease acquisition. J Infect Dis. 1999;180:1863–1868
  18. Sewankambo N, Gray RH, Wawer MJ, et al. HIV-1 infection associated with abnormal vaginal flora morphology and bacterial vaginosis. Lancet. 1997;350:546–550
  19. Gray RH, Kiwanuka N, Quinn TC, et al. Male circumcision and HIV acquisition and transmission: cohort studies in Rakai, Uganda. Rakai Project Team. AIDS. 2000;14:2371–2381
  20. Hunter DJ, Maggwa BN, Mati JK, Tukei PM, Mbugua S. Sexual behavior, sexually transmitted diseases, male circumcision and risk of HIV infection among women in Nairobi, Kenya. AIDS. 2000;8:93–99
  21. Fonck K, Kidula N, Kirui P, et al. Pattern of sexually transmitted diseases and risk factors among women attending an STD referral clinic in Nairobi, Kenya. Sex Transm Dis. 2000;27:417–423

 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

American Journal of Obstetrics & Gynecology
Volume 200, Issue 1 , Pages 42.e1-42.e7 , January 2009

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