Evidence map›Paper›PMID 28406272›Full record

ArticleJournal of the International AIDS Society2017

Dorsal longitudinal foreskin cut is associated with reduced risk of HIV, syphilis and genital herpes in men: a cross-sectional study in Papua New Guinea.

Andrew J Vallely, David MacLaren, Matthew David, Pamela Toliman, Angela Kelly-Hanku, Ben Toto, Rachael Tommbe, Zure Kombati, Petronia Kaima, Kelwyn Browne and 9 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of the International AIDS Society, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed
2.5field-weighted citation impact, top 12% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 13 citations in OpenAlex.

  1. Review
  2. Review
  3. Semen: A modulator of female genital tract inflammation and a vector for HIV-1 transmission.American journal of reproductive immunology (New York, N.Y. : 1989) · 2021
    Review
  4. Article
  5. Review
  6. Article
  7. A diagnostic evaluation of a molecular assay used for testing and treating anorectal chlamydia and gonorrhoea infections at the point-of-care in Papua New Guinea.Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases · 2019
    Article
  8. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

19 authors at 7 institutions in 2 countries.

Andrew J VallelyPublic Health Intervention Research Group, Kirby Institute, UNSW Australia, Sydney, Australia.
David MacLarenCollege of Medicine and Dentistry, James Cook University, Cairns, Australia.
Matthew DavidSexual and Reproductive Health Research Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
Pamela TolimanSexual and Reproductive Health Research Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
Angela Kelly-HankuPublic Health Intervention Research Group, Kirby Institute, UNSW Australia, Sydney, Australia.
Ben TotoSexual and Reproductive Health Research Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
Rachael TommbeSchool of Health Science, Pacific Adventist University, Port Moresby, Papua New Guinea.
Zure KombatiDepartment of Pathology, Tininga Clinic, Mt Hagen General Hospital, Papua New Guinea.
Petronia KaimaDepartment of Pathology, Tininga Clinic, Mt Hagen General Hospital, Papua New Guinea.
Kelwyn BrowneSexual Health and HIV/AIDS Prevention and Control, National Department of Health, Port Moresby, Papua New Guinea.
Clement ManinengCollege of Medicine and Dentistry, James Cook University, Cairns, Australia.
Lalen SimeonSchool of Health Science, Pacific Adventist University, Port Moresby, Papua New Guinea.
Claire RyanCentre for International Health, The Burnet Institute, Melbourne, Australia.
Handan WandPublic Health Intervention Research Group, Kirby Institute, UNSW Australia, Sydney, Australia.
Peter HillSchool of Public Health, University of Queensland, Brisbane, Australia.
Greg LawSexual Health and HIV/AIDS Prevention and Control, National Department of Health, Port Moresby, Papua New Guinea.
Peter M SibaSexual and Reproductive Health Research Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
W John H McBrideCollege of Medicine and Dentistry, James Cook University, Cairns, Australia.
John M KaldorPublic Health Intervention Research Group, Kirby Institute, UNSW Australia, Sydney, Australia.
Papua New Guinea Institute of Medical Research · PGPacific Adventist University · PGJames Cook University · AUMount Hagen Provincial Hospital · PGNational Department of Health · PGBurnet Institute · AUUniversity of Queensland · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionVarious forms of penile foreskin cutting are practised in Papua New Guinea. In the context of an ecological association observed between HIV infection and the dorsal longitudinal foreskin cut, we undertook an investigation of this relationship at the individual level.

methodsWe conducted a cross-sectional study among men attending voluntary confidential HIV counselling and testing clinics. Following informed consent, participants had a face-to-face interview and an examination to categorize foreskin status. HIV testing was conducted on site and relevant specimens collected for laboratory-based Herpes simplex type-2 (HSV-2), syphilis, Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV) testing.

resultsOverall, 1073 men were enrolled: 646 (60.2%) were uncut; 339 (31.6%) had a full dorsal longitudinal cut; 72 (6.7%) a partial dorsal longitudinal cut; and 14 (1.3%) were circumcised. Overall, the prevalence of HIV was 12.3%; HSV-2, 33.6%; active syphilis, 12.1%; CT, 13.4%; NG, 14.1%; and TV 7.6%. Compared with uncut men, men with a full dorsal longitudinal cut were significantly less likely to have HIV (adjusted odds ratio [adjOR] 0.25, 95%CI: 0.12, 0.51); HSV-2 (adjOR 0.60, 95%CI: 0.41, 0.87); or active syphilis (adjOR 0.55, 95%CI: 0.31, 0.96). This apparent protective effect was restricted to men cut prior to sexual debut. There was no difference between cut and uncut men for CT, NG or TV.

conclusionIn this large cross-sectional study, men with a dorsal longitudinal foreskin cut were significantly less likely to have HIV, HSV-2 and syphilis compared with uncut men, despite still having a complete (albeit morphologically altered) foreskin. The protective effect of the dorsal cut suggests that the mechanism by which male circumcision works is not simply due to the removal of the inner foreskin and its more easily accessible HIV target cells. Exposure of the penile glans and inner foreskin appear to be key mechanisms by which male circumcision confers protection.Further research in this unique setting will help improve our understanding of the fundamental immunohistologic mechanisms by which male circumcision provides protection, and may lead to new biomedical prevention strategies at the mucosal level.

Indexed as

Circumcision, MaleAdolescentAdultCross-Sectional StudiesForeskinHerpes GenitalisHIV InfectionsHumansMaleMiddle AgedPapua New GuineaPrevalenceRisk Reduction BehaviorSexual BehaviorSyphilisYoung Adultmale genital cuttingPacificsuperincision

Identifiers

PMID28406272
PMCPMC5515018
OpenAlexW2598704128

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

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.