Trial reportPLoS medicine2009
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.
Trial report in PLoS medicine, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02337179 (A Pilot Study to Introduce Male Circumcision), which is not on this map. Cited by 31 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
A Pilot Study to Introduce Male Circumcision (MC) Services to Prevent HIV Infection in Two High Prevalence Areas of the Dominican Republic (DR)
Who cites it
31 citing papers in PubMed, 2 syntheses or guidelines pooled it, 61 citations in OpenAlex.
- Critical evaluation of arguments opposing male circumcision: A systematic review.Journal of evidence-based medicine · 2019Pooled it
- A systematic review and meta-analysis of risk factors for sexual transmission of HIV in India.PloS one · 2012Pooled it
- HIV shedding from male circumcision wounds in HIV-infected men: a prospective cohort study.PLoS medicine · 2015Trial
- Medical male circumcision and herpes simplex virus 2 acquisition: posttrial surveillance in Kisumu, Kenya.The Journal of infectious diseases · 2013Trial
- Male circumcision significantly reduces prevalence and load of genital anaerobic bacteria.mBio · 2013Trial
- Circumcision status and incident herpes simplex virus type 2 infection, genital ulcer disease, and HIV infection.AIDS (London, England) · 2012Trial
- Microbial diversity of genital ulcer disease in men enrolled in a randomized trial of male circumcision in Kisumu, Kenya.PloS one · 2012Trial
- Male circumcision and risk of HIV acquisition among MSM.AIDS (London, England) · 2011Trial
- Does the evidence support circumcision of infant males in the United Kingdom?-a systematic review.Translational andrology and urology · 2026Review
- Age Patterns of HSV-2 Incidence and Prevalence in Two Ugandan Communities: A Catalytic Incidence Model Applied to Population-Based Seroprevalence Data.The Journal of infectious diseases · 2023Article
- How Does Voluntary Medical Male Circumcision Reduce HIV Risk?Current HIV/AIDS reports · 2022Review
- Infant Circumcision for Sexually Transmitted Infection Risk Reduction Globally.Global health, science and practice · 2022Article
- Non-therapeutic male circumcision in infancy or childhood and risk of human immunodeficiency virus and other sexually transmitted infections: national cohort study in Denmark.European journal of epidemiology · 2022Article
- Evidence-based circumcision policy for Australia.Journal of men's health · 2022Article
- Effectiveness of Voluntary Medical Male Circumcision for Human Immunodeficiency Virus Prevention in Rakai, Uganda.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2021Article
- Foreskin surface area is not associated with sub-preputial microbiome composition or penile cytokines.PloS one · 2020Article
- Physicians' and nurses' thoughts and concerns about introducing neonatal male circumcision in Thailand: a qualitative study.BMC health services research · 2018Article
- Canadian Urological Association guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants (full version).Canadian Urological Association journal = Journal de l'Association des urologues du Canada · 2018Article
- The biology of how circumcision reduces HIV susceptibility: broader implications for the prevention field.AIDS research and therapy · 2017Review
- Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
15 authors at 6 institutions in 2 countries.
Funding
Abstract
backgroundRandomized trials show that male circumcision (MC) reduces the incidence of HIV and herpes simplex virus type 2 (HSV-2) infections, and symptomatic genital ulcer disease (GUD). We assessed the role of GUD and HSV-2 in the protection against HIV afforded by MC. METHODS AND
findingsHIV-uninfected men were randomized to immediate (n = 2,756) or delayed MC (n = 2,775) in two randomized trials in Rakai, Uganda. GUD symptoms, HSV-2 status, and HIV acquisition were determined at enrollment and at 6, 12, and 24 mo of follow up. Ulcer etiology was assessed by PCR. We estimated the prevalence and prevalence risk ratios (PRRs) of GUD in circumcised versus uncircumcised men and assessed the effects of HSV-2 serostatus as a risk-modifying factor for GUD. We estimated the proportion of the effect of MC on HIV acquisition that was mediated by symptomatic GUD, and by HSV-2 infection. Circumcision significantly reduced symptomatic GUD in HSV-2-seronegative men (PRR = 0.51, 95% [confidence interval] CI 0.43-0.74), HSV-2-seropositive men (PRR = 0.66, 95% CI 0.51-0.69), and in HSV-2 seroconverters (PRR = 0.48, 95% CI 0.30-0.79). The proportion of acute ulcers due to HSV-2 detected by PCR was 48.0% in circumcised men and 39.3% in uncircumcised men (chi(2)p = 0.62). Circumcision reduced the risk of HIV acquisition in HSV-2 seronegative men (incidence rate ratio [IRR] = 0.34, 95% CI 0.15-0.81), and potentially in HSV-2 seroconverters (IRR = 0.56, 95% CI 0.19-1.57; not significant), but not in men with prevalent HSV-2 at enrollment (IRR = 0.89, 95% CI 0.49-1.60). The proportion of reduced HIV acquisition in circumcised men mediated by reductions in symptomatic GUD was 11.2% (95% CI 5.0-38.0), and the proportion mediated by reduced HSV-2 incidence was 8.6% (95% CI -1.2 to 77.1).
conclusionsCircumcision reduced GUD irrespective of HSV-2 status, but this reduction played only a modest role in the protective effect of circumcision on HIV acquisition.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.