Circumcision cited as defense against HIV in proposed CDC guidelines

The health benefits of circumcision outweigh the risks, the CDC says in new draft guidelines issued Dec. 2. Much of the evidence is based on studies in Africa. Above, a doctor and nurse perform a circumcision on a soldier in Harare, Zimbabwe.
(Tsvangirayi Mukwazhi / Associated Press)

The Centers for Disease Control and Prevention has released proposed guidance on circumcision that says the surgical procedure would help straight men in the United States reduce their risk of becoming infected with HIV, the virus that causes AIDS.

“Given the urgency of the HIV epidemic in the United States, CDC believes it is essential to maximize the impact of all available prevention options,” the CDC said in the guidelines. “Male circumcision is one strategy that may help reduce the continued spread of HIV in the U.S.”

The draft guidance, published Tuesday in the Federal Register, states that all uncircumcised, sexually active straight males and adolescents — as well as parents of newborn males — should be counseled by their doctors on the key risks and benefits of circumcision.


The guidelines also emphasize that “male circumcision is a voluntary procedure” and that decisions about circumcision should take “personal, cultural, religious and ethical beliefs” into account.

Clinical trials and observational studies have found that men who are circumcised are less likely than their uncircumcised peers to acquire sexually transmitted infections during vaginal sex. Being circumcised reduced the risk of infection with HIV from a female sexual partner by 50% to 60%. It also reduced the risk of getting genital herpes by up to 45% and of getting cancer-causing strains of human papillomavirus by 30%.

However, circumcision did not reduce the risk of getting HIV or other infections during anal sex with other men.

Studies have also found that sex with circumcised men is safer for women. They are less likely to become infected with HPV, bacterial vaginosis and trichomoniasis, the CDC guidelines state. There is no medical evidence linking male circumcision to reduced risk of HIV for female partners, the guidelines note.

The CDC states that the risk of adverse events from circumcision is low, and that minor bleeding and inflammation are the biggest problems. The agency says complications arise in less than one-half of 1% of newborns, 9% of children and about 5% of adults.

“Severe complications can occur but are exceedingly rare,” the CDC wrote.

In making the case that the health benefits of circumcision outweigh the risks, the federal agency tacitly endorsed the position of the American Academy of Pediatrics.

“Although health benefits are not great enough to recommend routine circumcision for all male newborns, the benefits of circumcision are sufficient to justify access to this procedure for families choosing it and to warrant third-party payment for circumcision of male newborns,” the pediatrician group said in a policy statement issued in 2012.

About 58% of newborn boys in the U.S. are circumcised before they leave the hospital, according to the CDC.

Release of the draft recommendation kicked off a 45-day public comment period, and opponents of the controversial practice vowed to make their voices heard.

Among a number of concerns, opponents of circumcision, or “intactivists,” say it’s wrong to perform permanent elective surgery on a newborn. That decision can only be made by a consenting adult, they say.

“If someone feels they need to cut off the best part of their penis when they’re 18 ... the choice should be up to the person who’s being subjected to the surgery,” said Lloyd Schofield, who once petitioned to have the procedure banned in San Francisco. “That’s the crux of our message.”

Dr. Thomas Newman, a professor of epidemiology and biostatistics at UC San Francisco, says he believes that the medical benefits of circumcision outweigh the risks but that both are small.

Wondering whether a significant number of men who were circumcised as newborns are unhappy with their parents’ decision, Newman said: “Some certainly are quite distressed about their neonatal circumcisions.”

The CDC noted in its guidelines that circumcision is “simpler, safer and less expensive” for infants than it is for adults. Yet it also wrote that “delaying circumcision until adolescence or adulthood enables the male to participate in — or make — the decision.”

“Adult men who undergo circumcision generally report minimal or no change in sexual satisfaction or function,” the agency added.

While the draft statement focused on circumcision’s benefits in fighting HIV and sexually transmitted infections, AIDS activists expressed doubt that it would make much difference here.

“Since the epidemic in the United States is being driven primarily by men who have sex with men, we’re not sure if it’s relevant for gay men in this country,” said Vallerie Wagner, director of health and wellness programs at AIDS Project Los Angeles.

Twitter: @montemorin