Thursday, July 21, 2011

Would you choose Gardasil or circumcision against HPV?

I know that guys who haven’t been snipped hate to hear this, but a new study in South Africa might make you want to revisit the subject of circumcision in terms of HIV, HPV, genital warts, etc. (and make women check out prospective partners a little more closely). The study shows that circumcision reduces the risk of contracting HIV by 76 percent.

76 percent. WOW. And of course, if you don’t get HIV, you’re not going to pass it along to your partner(s), either.

While it’s hard to say whether those statistics would hold up in the US, where life, health and risks are different, it’s hard to imagine that circumcision could make less than a very worthwhile difference in transmission rates. And it’s not just a matter of cleanliness. The cells in the foreskin are particularly vulnerable to viruses.

Oh, and then there’s the nasty subject of genital warts. Circumcision cuts (sorry) that chance by 28-34 percent, too, according to another randomized trial in Africa.

HPV? Not so much. One study found a 27.9% prevalence of high-risk HPV genotypes in uncircumcised males and only an 18.0% prevalence in circumcised males. Their female partners’ risk was 38.7% (uncircumcised partner) and 27.8% (circumcised partner) and it is, of course, impossible to know which way the infection went. But that’s still significant, either as an adjunct to the HPV vaccine series—whether Gardasil or Cervarix—or as part of a well-thought out strategy to lower risk.

As reported by Michael Smith for MedPage Today: “The procedure offers limited protection against most high-risk types, (researchers) noted, while the HPV vaccine is highly effective, but only against a limited number of genotypes. "The two interventions are likely to have important synergistic effects," they concluded.

The odd thing is that Medicaid, which serves some of our most vulnerable populations, doesn’t pay for circumcision in 16 states, and yet the US is currently paying for males to get circumcised in Swaziland to the total tune of $30 million. Talk about “things that make you go hmmmmmmm…”

The current pro-Gardasil campaign has perhaps made many people lose sight of the fact that there’s a heck of a lot worse things out there than HPV. With rates of women getting their annual check-ups already dropping in Australia, where Gardasil has been provided free by the national health system, it’s clear that the vaccine carries a subconscious feeling of… phew, I’m safe from STDs.

You’re not. Whether you choose Gardasil or not, just remember that a multi-pronged (sorry again) approach to sexual health is crucial. Keep your immune system healthy (get enough sleep and enough veggies and fruits, quit smoking etc.), use condoms (which will help against HPV and HIV but won't eliminate the risk, particularly for HPV), and apply the infamous Seinfeld “sponge-worthy” criteria to potential partners (is he/she really worth it?).

And guys, it’s up to you. If you’re not circumcised, think about it for your sake and your partner’s sake. Would you do it? If not, why not?


Anonymous said...

any comments on the times article in favor of gardasil vaccination for men/boys?

Kristin Johns said...

It makes me think that if I were a gay male, with no personal or familial history of autoimmune disease, I'd sure want to consider the Gardasil vaccine!

That's the thing with Gardasil. It shouldn't be a blanket recommendation. Individuals need to be honest about their lifestyle, sexuality, and family health history. Doctors need to listen--and help patients make a choice that makes sense for them.

Incidentally, anal cancer is pretty curable if caught early, so that's another simple exam to ask your doctor for. If, of course, you can afford one. And THAT's a whole different subject.

Anonymous said...

Are you joking? I believe my deep lifelong unhappiness can be traced directly back to having been mutilated soon after birth.

If I had a son, I would never subject him to circumcision. I would ge4t him Gardasil as soon as I could. I am considering foreskin restoration for myself. My wife will have to make sure she gets her Pap smears as she is mad about the risk to her, which I think is over stated.

Kristin Johns said...

I honestly don't have any response to that. Good luck.

Anonymous said...

Gardasil seems like a questionable option, given that we may not yet know all the side effects. Circumcision seems to be the more reasonable option.

Anonymous said...

Definitely circumcision. Plus staying healthy.

Anonymous said...

Circumcision is listed as a non-medically necessary surgery that is preformed on baby boys. By being listed as non-medically necessary Medicaid in some states will no longer pay for this procedure. Some group and private health insurance companies are also refusing to pay for this. But medical research has shown that this procedure does have very important medical benefits.

Studies done have shown that a woman who is in a sexual relationship with a man that is circumcised is less likely to acquire cervical cancer than a woman who is with a man that is not circumcised. This reduction in cervical cancer shows one of the medical benefits of circumcision. The reason that circumcision has been linked to reducing the risks of cervical cancer is that circumcision reduces the risk of contracting the Human Papillomavirus. It is this virus that can cause cervical cancer.

How can medical insurance companies call this procedure non-medically necessary when studies have shown that this simple procedure preformed on a baby can in the future help reduce his future sexual partner from acquiring cervical cancer.

After all some states are now trying to force young girls to have to have the HPV vaccine. The HPV vaccine is meant to protect against the Human Papillomavirus which causes genital warts and can lead to cervical cancer is a woman. So here the laws are forcing this vaccine to help to prevent cervical cancer but why are they not making it mandatory for the boys to be circumcised. After all circumcision reduces the risk of cervical cancer just like the vaccine does. But the vaccine is being forced on girls.

Why shouldn’t both preventions be forced on both sexes? Girls are starting to have this vaccine forced on them while for boys circumcision is still elective.

Other studies have shown that circumcision can reduce a man’s chances of contracting HIV by up to 60 percent. The reason circumcision helps to reduce a man’s risk when it come to HIV is that the foreskin is that the foreskin is very porous making it easier for the virus to enter into the bloodstream. These studies were conducted in Africa where the rate of HIV and AIDS is very high. Circumcision is not a common practice in remote areas of Africa.

Circumcision reduces the risks of acquiring HIV. Circumcision reduces the risk of catching the Human Papillomavirus. Circumcision reduces the risks of cervical cancer for his future partners. It is clearly shown that circumcision is just as medically necessary as the HPV vaccine for girls.

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