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low risk or no risk? (uncut)
Jul 8, 2005

hey doc! first of all, i want to thank you for this great job that you are doing!

my question is with regards to circumcision, i read in your previous forums that being uncut doesnt increase your risks, however yesterday I read a study on your website that in fact there is more risk for uncut men. I had unprotected insertive oral with a sex worker recently, and no other escapades since then..

also, in the older forums, i noticed that questions regarding insertive oral used to be answered by no risk or virtually none but recently its become low risk and .5 in ten thousand.... what brings up this difference? Heading towards one month waiting to reach three month mark so I can test. What are your thoughts? Been feeling a lot of fatigue lately, dont know if its a symptom or just me worrying.

thanks!

Response from Dr. Frascino

Hi,

Here's the latest scoop on cut versus uncut: a French and South African study was recently halted early because initial results indicated that adult male circumcision reduced the risk of HIV infection. The report stated that circumcision reduced the risk of contracting HIV by 70 percent. (That's even better than the 30 percent risk reduction set as a target for some HIV/AIDS vaccine trials!) The circumcision study was stopped early because it was deemed unethical to continue the trial after this preliminary data showed such dramatic results. The men in the study had been followed for at least a year.

The reason this is making news is because this was the first of three large clinical trials looking at circumcision and HIV risk. There are a lot (30 or more) of smaller, not very rigorous studies that have been done in the past suggesting cut men were less likely to become infected.

There are two other studies still in process one in Uganda, the other in Kenya. If these studies confirm what this first well-controlled trial shows, circumcision could significantly decrease the number of new infections per year currently nearly five million!

Laboratory studies have shown that the foreskin contains lots of white blood cells, which can be a target of HIV. Consequently, surgical removal of the foreskin a relatively simple, low-cost and permanent medical intervention may well have a significant protective effect.

Stay posted to The Body and we'll keep you informed as this story unfolds (or should that be gets cut off?).

Regarding the estimated per-act risk for acquisition of HIV by various exposure routes, it continues to evolve as we get new information. (Except of course in Kansas, because as everyone knows, there is no evolution in Kansas.) The statistic you quote is form a recent CDC publication.

Good luck.

Dr. Bob



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