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Circumcision and HIVrecent study from New England Journal of Medicine
Apr 23, 2009

Dear Dr. Bob,

I know you get a lot of prevention questions, but maybe not too many about preventing HIV transmission 15+ years from now!

So I am pregnant with my second son and just read about the new study published in the New England Journal of Medicine that found that circumcision greatly reduces the risk of HIV, herpes, and HPV. I know this theory has been around for a while, but this study claims to prove beyond a doubt the value of circumcision.

We did not circumcise our first son (now 2 years old) based on the American Academy of Pediatrics stance at the time that there is not strong enough scientific evidence to recommend routine circumcision. We decided that the procedure was not necessary for his health and thus opted not to do it. But now this new study has me wondering what to do with our second son (due in 1 month) and also if we should consider having our first son circumcised at some point soon (poor kid, I know, I know). I believe that the American Academy of Pediatrics is reviewing their stance on this as we speak.

Okay, so my question is do you believe the evidence is strong enough to recommend routine circumcision or is the jury still out? I know nothing will ever take the place of safer sex / condom use and we plan to teach our boys everything we can so they are prepared to protect themselves and their partners.

I really trust your advice so any thoughts would be greatly appreciated.

Thanks!

Response from Dr. Frascino

Hi,

Yes, the American Academy of Pediatrics is reviewing its position statement on circumcision. Yes, circumcision has been associated with decreased risk of HIV (and other STDs) for heterosexual couplings. However, the best HIV/STD-prevention method remains the proper and consistent use of latex (or polyurethane) condoms. Circumcision can be thought of as adding an additional level of harm reduction. Of course none of us knows what HIV-prevention methods may be developed in the next 15 years, but if it were up to me, I'd lean toward circumcision today.

Good luck with your upcoming new addition.

Dr. Bob



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