The decreased risk of HIV infection in circumcised men cannot be explained
by a reduction in sores from conditions such as herpes, according to
research published in PLoS Medicine.

In further analyses of data from 2 clinical trials including more than
5,000 men in rural Uganda, which had shown that circumcision reduced the
risk
of HIV infection in men by about 60%, Ron Gray of the Johns Hopkins
Bloomberg School of Public Health and colleagues investigated factors
associated
with that reduction in risk. Specifically, they investigated whether
infection with HSV-2, the virus that causes genital herpes, and whether
genital
ulcers of any cause, could account for the lower rates of HIV infection in
the circumcised study participants.

The researchers found that reduction in symptomatic genital ulcer disease
accounted for only about 10% of the protective effect associated with
circumcision, and did not find any consistent role for HSV-2 in
counteracting protection. These results indicate that most of the
reduction in HIV
acquisition provided by male circumcision may be explained by the removal
of vulnerable foreskin tissue containing HIV target cells. They also
suggest
that circumcision reduces genital ulcer disease primarily by reducing the
rate of ulceration due to causes other than herpes, including sores caused
by mild trauma during intercourse.

Funding:
The trials were funded by the US National Institutes of Health
(#U1AI51171), the Bill & Melinda Gates Foundation (#22006.02), and the
Fogarty
International Center (#5D43TW001508 and #D43TW00015). This study was also
supported by the Intramural Research Program of the National Institute of
Allergy and Infectious Diseases, NIH. The funders had no role in study
design, data collection and analysis, decision to publish or preparation
of
this manuscript.

Competing Interests:
The authors have declared that no competing interests exist.

Citation:
“Effects of Genital Ulcer Disease and Herpes Simplex Virus Type 2 on the Efficacy of Male Circumcision for HIV Prevention: Analyses from the Rakai Trials.”
Gray RH, Serwadda D, Tobian AAR, Chen MZ, Makumbi F, et al. (2009)
PLoS Med 6(11): e1000187. doi:10.1371/journal.pmed.1000187

Source
PLoS Medicine

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