割包皮状态不会影响妇女的性病风险


  August 7, 2007 (西雅图) — 男性割包皮 (MC)可以减少其感染HIV的风险,而新的证据 — 三项最近的随机控制试验和观察研究的分数— 支持这项已经大量运用外科手术所进行的预防方式;不过,较鲜为人知的是,MC是否可以减少妇女的非HIV类性病(STIs) ;国际性病研讨会第17届年会中所发表的一篇新研究指出, 男性割包皮的保护效果不会转移到其女性性伴侣,也就是STI风险不会因此减少。
  
  这个多中心研究分析一项前溯式世代研究( HC-HIV 研究)的5,925位非洲和泰国女性资料,探索荷尔蒙避孕法和HIV或者STI之间的关联,发现 MC 不会显著降低妇女的淋病、滴虫、披衣菌感染风险。
  
  共同作者,北加州大学医学副教授William C. Miller表示,另一半有割包皮的妇女,与另一半没有割包皮的妇女之间,STI发生率只有一些不同— 所以我们结论认为割包皮对此一族群实在没有效果;他指出,也没有确切证据支持MC可以保护男性免于研究中的这三种STIs,尽管男性包皮为病原菌生长的「好客」环境是众所皆知的事情。
  
  此研究之研究对象是低STI风险的妇女(平均年纪25岁),参与者在开始时以及每3个月接受临床检查和取样,为期15到24个月;整体来说,52%参与者的另一半有割包皮,87%与另一半同居,招募参加研究时仅有9 位妇女有STI。
  
  终点时,另一半有割包皮的妇女,每100人年(PY)披衣菌发生率是4.5, 另一半没有割包皮的妇女,每100 PY披衣菌发生率是3.9;淋病方面,两组的结果分别是 3.7 和 3.1;滴虫方面,两组的结果分别是4.7 和3.9。
  
  在多变项分析中,控制避孕方式、年纪、初次性行为年纪、国家、校正危害比(HR)之后,比较另一半有割包皮的妇女与另一半没有割包皮的妇女,披衣菌感染是1.22 ,淋病感染是 0.93;有趣的是,仅有一位性伴侣的妇女之中,另一半有割包皮的妇女,其披衣菌风险还比较高 (1.01 vs 1.75; HR, 1.33)。
  
  华盛顿大学AIDS与性病中心主任King Holmes博士表示,整体来说,研究发现不令人感到意外,但他们确实指出需要长期研究;此研究是有趣的,但重点是披衣菌和淋病是包含在尿道而不是阴茎上皮,所以他们不是受男性割包皮影响的疾病元凶,除非是软性下疳(Chancroid)、疱疹(Herpes)、梅毒(Syphilis),我认为问题依然存在,男性割包皮是否与增加阴道细菌增生症(Bacterial Vaginosis)风险有关 — 有些资料显示另一半没有割包皮的妇女其风险增加。
  
  Miller医师指出研究限制,特别是次级资料和自我报告的性行为资料的可信度,他也指出,虽然MC在全球被用来阻断HIV传播,但男性割包皮对妇女STI风险的效果仍未知。
  
  Miller医师和Holmes医师报告没有相关财金关系。
  
  国际性病研讨会第17届年会:摘要 449。发表于2007年7月30日。

Circumcision Status Does Not A

By Bonnie Darves
Medscape Medical News

August 7, 2007 (Seattle) — Male circumcision (MC) has been found to reduce risk of HIV acquisition for the men themselves, and the emerging body of evidence — 3 recent randomized controlled trials and scores of observational studies — supporting this has spawned strong interest in employing the surgical procedure as a preventive measure. Little has been known, however, about whether MC reduces the risk of non-HIV sexually transmitted infections (STIs) in women. A new study, presented here at the 17th Meeting of the International Society for Sexually Transmitted Diseases Research, suggests that the protective effect of MC may not transfer to STI risk reduction in female sexual partners.

The multicenter study, analyzing data from a prospective cohort study (the HC-HIV Study) of 5925 African and Thai women on the association between hormonal contraception and HIV or STI, found that MC did not significantly reduce women's risk of acquiring gonococcal, trichomonal, or chlamydial infections.

"There was little difference [in STI incidence] between the women with circumcised partners and those with uncircumcised partners — so we concluded that there really was no effect of circumcision in this population," said study coauthor William C. Miller, MD, PhD, MPH, associate professor of medicine at the University of North Carolina at Chapel Hill. He noted that there also is no conclusive evidence that MC is protective against men's acquisition of the 3 STIs studied, despite the fact that male foreskin is known to be a "hospitable" environment for pathogen growth.

The study was conducted in a population of women who were primarily at low risk for an STI (mean age, 25 years). The participants underwent clinical examination and specimen collection at baseline and every 3 months for a period of 15 to 24 months. Overall, 52% of participants reported having a circumcised partner, and 87% cohabited with their partner. Only 9 of the women were found to have an STI at enrollment.

At endpoint, the incidence of chlamydia per 100 person years (PY) was 4.5 in women with circumcised partners compared with 3.9 per 100 PY in the women with uncircumcised partners. Respective results for gonococcal infection were 3.7 and 3.1 and were 4.7 and 3.9 for trichomonas. In multivariate analysis, after controlling for contraceptive method, age, coital debut age, and country, the adjusted hazard ratio (HR), comparing women with circumcised partners with those with uncircumcised partners, was 1.22 for chlamydia and 0.93 for gonococcal infection. Interestingly, in analyses of the women who reported having only 1 sexual partner, women with circumcised partners appeared to have slightly higher risk of chlamydia (1.01 vs 1.75; HR, 1.33) than those with uncircumcised partners.

Overall, the findings did not surprise King Holmes, MD, PhD, director of the Center for AIDS and Sexually Transmitted Diseases at the University of Washington in Seattle, but they did, he suggested, indicate the need for longer-term study. "The study is interesting, but one point to make is that chlamydia and gonorrhea involve the urethra and not the penile epithelium, so they're not the prime suspects for diseases that are affected by male circumcision," he said, unlike diseases such as chancroid, herpes, and syphilis. "The question that remains, I think, is whether male circumcision will be associated with increased risk of bacterial vaginosis — some data have suggested that women with uncircumcised partners have an increased risk."

Dr. Miller acknowledged the study's limitations, particularly its reliance on both secondary data and self-reported sexual and behavioral data. He also noted that although MC interventions are being planned worldwide to stem transmission of HIV, "the effect of [male] circumcision on women's STI risk is not yet known."

Dr. Miller and Dr. Holmes report no relevant financial relationships.

17th Meeting of the International Society for Sexually Transmitted Diseases Research: Abstract 449. Presented July 30, 2007.

    
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