Routine Circumcision Could Reduce STD Rate

A new study in Pediatrics suggests routine male circumcision could reduce the rate of STDs by around half. The report adds to growing scientific evidence that runs contrary to an American Academy of Pediatrics (AAP) policy against the practice.

Researcher David Fergusson of New Zealand's Christchurch School of Medicine and Health Sciences and colleagues followed 510 New Zealand newborns until age 25. Even after adjusting for other key factors linked to STDs -- number of sexual partners, unprotected sex and family demographics -- youths who were circumcised were far less likely to become infected. It is believed that the warm, moist area under the foreskins of uncircumcised men functions as a catalyst for infections.

Since AAP came out against routine circumcision in 1999, mounting research has shown that circumcised boys are less likely to get HIV and some other STDs, said Thomas Wiswell, a neonatologist and professor of pediatrics at the University of Florida in Gainesville. Concurrently, the rate of circumcision in the United States has been dropping.

AAP's policy acknowledges there are potential medical benefits to circumcision, such as lowered risk for urinary tract infections in infants and penile cancer at any age -- two conditions that are fairly rare. The main complications resulting from circumcision are bleeding and infection, also rare and seldom serious, the pediatrics groups says. However, AAP argues there are not enough benefits to justify routine circumcision, so the decision should be left to parents.

Such policies guide doctors on what to tell parents. "The benefits of circumcision far outweigh risks, and doctors should be telling parents that," said Edgar Schoen, a pediatrician and consultant at Kaiser Permanente Medical Center in Oakland. "The academy has been derelict and irresponsible in taking the stand they did," he said.

AAP President Jay Berkelhamer said the new study indicates it is time to reconsider the evidence. "People feel very passionate on both sides, but I'm going to recommend that we take another careful look at this," he said.

Jack Swanson, a pediatrician in Ames, Iowa, who helped draft the AAP policy in 1999, noted that studies focus on varying populations and also vary in quality. "We need to look at the risk-benefit ratio overall, and that's not always easy."

The study, "Circumcision Status and Risk of Sexually Transmitted Infection in Young Adult Males: An Analysis of a Longitudinal Birth Cohort," was published in Pediatrics (2006;118(5):1971-1977).

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