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Uncircumcised risks
Dec 21, 2005

Dear Doctor Bob,

Hi there, how's it hanging? Before I ask my question, I wanted to offer my warmest and most heartfelt thanks for all that you do, not only for me but all the other worried wells out there in our time of crisis and despair. Your knowledge, compassion and wit are beyond reproach. A donation to your foundation is forthcoming shortly.

Okay, enough with the cheese (although I mean every word I say!). My question is this: They say that being uncircumcised increases the risk for contracting the HIV disease during sexual activity. Are there statistics that show exactly how much more of a risk is associated with being uncircumcised? I know there was a study in Africa that mentioned something along these lines.

I am uncircumcised and engaged in protected vaginal sex, unprotected oral, where I received, and lots of fingering with 2 sex workers in the Carribean while on business. Upon return , a few days later I noticed that I had blood coming out of a cuticle on my finger, the same finger I used for fingering. Perhaps it was due to colder weather, but I hope it wasn't open during fingering. Anyway, a few days later I suffered from severe fatigue, dizziness, weight loss and constant urination. I got checked out by my doctor a week later and everything was negative. Now, a little after 4 weeks I swear i'm seroconverting. I have a general feeling of malaise, tiredness, a bit of a stuffy nose (although I can still smell fine). Every day I'm noticing more and more irregularities such as pimples on my body, sore neck, and itchy skin. I even looked at the internet and it looks as though I also have oral thrush and OHL! God, I freaking out.

What are your thoughts doctor? Sorry for the long e-mail. Thanks for all your time and I look forward to your response, if you choose to answer.

Response from Dr. Frascino

Hi,

How's it hanging? Hmmmm.... It's hanging to the left where it usually is. Thanks for asking.

What are my thoughts? I absolutely agree with your assessment of your situation. You are indeed "freaking out!" However, I don't really see any reason for your freak-out! Your HIV risk is minimal and your symptoms, questionable at best. I doubt you have thrush or OHL. If you feel you've placed yourself at risk for STDs, including HIV, get screened. However, remember you'll need to wait for the three-month mark to get a definitive HIV-antibody test result.

Regarding the increased HIV-transmission risk associated with being uncut, I'll post a question from the archives that addresses these concerns.

Good luck! Stop Freaking!

Dr. Bob

I need numbers!!!!! PLEASE! It'll help me through the wait... Sep 3, 2005

You recently wrote.."uncut men who have unprotected vaginal sex with HIV-positive partners are at a significantly increased risk for acquiring the virus."

Precisely how significant an increase?

Thanks

Response from Dr. Frascino

Hi,

As with 99% of the questions pouring into my inbox, the answer to your query is already waiting for you in the extensive archives of this forum. I'll repost a few questions addressing what we know so far about the cut vs. uncut story to demonstrate this fact. I'll also encourage folks waiting for a response from me to please check the archives!!! There is only one of me, but there are thousands of responses in the archives (that I've generated over the years). Dr. Bob

Less rish if circumcised (Jul 28, 2005)

Dr. Bob,

I'm a former worried well and current woo hoo...and am very happy with this status I might add. I saw a report on the news this morning that in a study it was found that if you are circumcised you have a 65% less chance of contracting HIV.

Just wondering if this is true and if so how?

Anyways...thanks for the good work.

God bless,

John

Response from Dr. Frascino

Hello,

A study was presented at the International AIDS Society Conference in Rio de Janeiro two days ago that suggested male circumcision might reduce the risk of female-to-male HIV transmission by 65%. I have written about the preliminary results of this study several times over the past month. I'll include one of those posts from the archives as well as a recent summary of the presentation and reaction to this news. That should bring you up to date on whether you should call the mohel.

Stay tuned to The Body for additional information as this story evolves.

Dr. Bob

Male Circumcision Might Reduce Risk of Female-to-Male HIV Transmission by About 65%, Study Presented at IAS Meeting Says July 27, 2005

Male circumcision can reduce by about 65% the risk of men contracting HIV through sexual intercourse with women, according to a study conducted by French and South African researchers and presented Tuesday at the 3rd International AIDS Society Conference on HIV Pathogenesis and Treatment in Rio de Janeiro, Brazil, BBC News reports (BBC News, 7/26). The randomized, controlled clinical trial enrolled more than 3,000 HIV-negative, uncircumcised men ages 18 to 24 living in a South African township (AFP/Yahoo! News, 7/26). Half of the men were randomly assigned to be circumcised, and the other half served as a control group, remaining uncircumcised (Reuters Health, 7/26). Bertrand Auvert, who coordinated the study for France's National AIDS Research Agency, said that after 21 months, 51 of the uncircumcised men had contracted HIV, compared with 18 of the circumcised men. The procedure "prevented six to seven out of 10 potential HIV infections," Auvert said (Astor, AP/Long Island Newsday, 7/27). He added that because the men in the study identified themselves as heterosexual, the results cannot be generalized to male-to-male or male-to-female transmission (Reuters Health, 7/26).

Reaction

Although UNAIDS expressed "considerable interest" in the study, the agency emphasized that more research is required to determine the true effectiveness of circumcision in preventing female-to-male HIV transmission. The results of two NIH-funded studies under way in Kenya and Uganda could shed more light on male circumcision in different social and cultural environments. If circumcision proves to be an effective tool to help curb the spread of HIV, the procedure still will need to be part of a comprehensive prevention package. "Although UNAIDS believes that it is premature to recommend male circumcision services as part of HIV prevention programs, there is heightened interest from governments and the general public in male circumcision in a number of African countries," the agency said in a release (UNAIDS release, 7/26). "While these results are very promising, we need to put them in a broader context to see the full benefits of circumcision," Charles Gilks, head of treatment, prevention and scale up at the World Health Organization HIV/AIDS Programme, said. Gilks said he worries that the study could make many circumcised men believe they cannot contract HIV and lead them to engage in sex without a condom. In addition, he said WHO is rushing to set guidelines for safe and hygienic circumcision, as many men might seek to undergo the procedure after hearing of the study results. Gilks also said he is concerned that traditional healers might try to perform circumcisions without the proper training and without educating men about HIV/AIDS prevention methods (AP/Long Island Newsday, 7/27).

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. Bob

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

Oral sex and circumcision (Jul 31, 2005)

Dr. Franscino,

thank you for all of the great advice you give. I have a question about oral sex and circumcision. Alot has been said nowadays about the risk of adquiring HIV if you are uncut. I have had a number or oral sex experiences with people where i don't know what their status is. Does the fact that i am uncut raise the chance of me getting HIV?

Response from Dr. Frascino

Hello,

The risk of acquiring HIV from any kind of oral sex is very low. The information we have about circumcision pertains to female-to-male unprotected vaginal sex. The results cannot be generalized to male-to-male transmission, male-to-female transmission, oral sex or anal sex.

Dr. Bob



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