The good news for the uncircumcised, according to this study at least, is that they are no more likely to acquire human papillomavirus (HPV) than their clean-cut counterparts. But -- and here's the bad news for foreskin lovers -- it takes the uncircumcised a whole lot longer to get rid of HPV than circumcised dudes. The study found that clean-cut males can shed HPV in 91 days, compared to 154 days in uncircumcised males. The researchers concluded, "Circumcision may protect against HPV‐associated disease by enhancing the resolution of infection."
Here's the Reuters story:
Sex virus lasts longer in uncircumcised men
Wed Apr 14, 2010 2:27pm EDT
NEW YORK (Reuters Health) - While uncircumcised men don't seem to be at higher risk of acquiring human papillomavirus (HPV), it takes them longer to clear the virus from their bodies, new research shows. Because HPV causes genital warts and certain cancers, the finding, say researchers, could help explain why uncircumcised men have a higher risk of such penile cancers.
It could also play a role in how likely their partners are to develop infections.
Wed Apr 14, 2010 2:27pm EDT
NEW YORK (Reuters Health) - While uncircumcised men don't seem to be at higher risk of acquiring human papillomavirus (HPV), it takes them longer to clear the virus from their bodies, new research shows. Because HPV causes genital warts and certain cancers, the finding, say researchers, could help explain why uncircumcised men have a higher risk of such penile cancers.
It could also play a role in how likely their partners are to develop infections.
"Our study demonstrates that the apparent protective influence of circumcision against genital HPV infection may not involve a reduction in new infections but rather the enhanced ability to resolve existing HPV infections," Dr. Brenda Y. Hernandez of the Cancer Research Center of Hawaii in Honolulu and her colleagues write.
But why this might be, and whether circumcision would be a good way to help prevent the spread of HPV-related disease, remains unclear, according to the researchers.
Some HPV strains cause cervical cancer in women, and are the targets of the vaccines Cervarix and Gardasil. Some strains may also be associated with penile cancer in men.
There's evidence that circumcision lowers a man's likelihood of developing cancer of the penis and contracting HPV infection, as well as HIV infection, in some populations. Because partners of uncircumcised men face a higher risk of cervical cancer, it's possible that circumcision could affect the spread of the virus as well, Hernandez and her team note.
The researchers had previously found that circumcised men were less likely than their uncircumcised peers to be infected with HPV at a given point in time. To determine if circumcision might influence a man's risk of acquiring HPV infection, as well as how readily he could clear the virus from his body, the researchers followed 357 men for an average of about 14 months. Every two months, the men, 290 of whom were circumcised, underwent HPV testing.
During the study, the researchers identified 536 different HPV infections, with no difference in risk between the circumcised and uncircumcised men. However, the researchers did find that HPV infections of the head, or glans, of the penis lasted 154 days, on average, in the uncircumcised men, compared to 91 days in the men who were circumcised. The increased duration was seen for both cancer-associated and non-cancer-associated HPV strains.
Cancer of the penis most commonly develops in the glans, Hernandez and her team point out, and the fact that infection with cancer-related strains lasted longer in uncircumcised men "has clinical significance."
It's possible, they add, "that transmission of HPV to sex partners is more efficient among circumcised men because of the greater duration of their infection." However, they add, "whether circumcision is an effective means of facilitating HPV clearance has yet to be demonstrated."
Here is an exert from a more detailed article discussing the same study :
ReplyDelete"But the public-health value of circumcision in other countries, including the U.S., is under debate. In the U.S., most HIV infections are related to homosexual sex or IV drug use, and studies have found no good evidence that circumcision lowers HIV transmission among men who have sex with men.
With HPV, in contrast, it's estimated that most sexually active people in the U.S. will carry some strain of the virus at some point in their lives. However, any risk reduction from circumcision might have little public-health impact in the U.S. -- where Pap screening for cervical cancer is routine, penile and anal cancers in men are uncommon, and HPV vaccination is available for girls and women.
"My personal feeling," Gray said, "is that we shouldn't make any specific recommendations (on newborn circumcision)."
But even in countries where circumcision is recommended for HIV prevention, the procedure may have only "marginal" effects on the population prevalence of HPV, according to an editorial published with the studies.In developed countries where the expensive HPV vaccines are available, the shots are the "preferred public health strategy" for preventing HPV-related diseases, according to the editorialists.
SOURCE: Journal of Infectious Diseases, May 15, 2010
Hmm... what a shocker... the impact of this in the US would be negligible at best, and there is STILL a better and less invasive way of achieving even better results. Who woulda thunk it.
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DeleteAnd doubtless women will clear HPV infections quicker if they have had their labia removed. I'm not holding my breath waiting for the studies, though, let alone the recommendation.
ReplyDeleteHugh, I think that might be a good experiment. It seems biologically plausible - less tissue to get infected => faster clearance. I don't think the labia are known to be any more sexually sensitive than a foreskin, but safe removal would be more difficult, although not so much with modern medical technology. Apparently many women are now getting their labia trimmed anyway in the U.S., so a study might be possible. And with 140 million circumcised women in the world, it should be possible to answer this interesting question with studies in other countries.
ReplyDeleteI do find it amusing that our anti-circumcision friends respond to hard scientific data by speculating about whether a protective effect might also occur in women. :-)
ReplyDelete"I do find it amusing that our anti-circumcision friends respond to hard scientific data by speculating about whether a protective effect might also occur in women. :-)"
ReplyDeleteIf it was TRULY about saving lives researchers would test all these hypothesis on women, considering that women make up over 60 percent of HIV infections in Africa. As another anonymous pointed out, labiaplasties and vagioplasties are becoming increasingly popular and there are millions of women in the world who are already circumcised. I have not seen any hard evidence that removing just "extra folds of skin" on a woman is in anyway more harmful than removing the foreskin in men. In fact, studies have shown the stark opposite.Many women are not even put under anesthesia during "female genitcal mutilation" here.
Of course there are many degrees of severity in female circumcision, and removing the clitoris would be unethical.
" A nationwide clinical study investigating the outcomes of 341 separate procedures on 258 different women, from 12 genital plastic surgeons in 8 states will soon appear in the medical literature, in the Journal of Sexual Medicine (2).
The study found an overall satisfaction rate of 97.2% for women undergoing labiaplasty and clitoral hood reduction,
An overall satisfaction rate of 83% in women having a vaginal tightening procedure (vaginoplasty/perineoplasty), and 91.2% for women combining both “outer” and “inner” work.
The clinical study also cited data specifically regarding improvement in sexual satisfaction with 92.8% of women having both experienced improvement in their sexual satisfaction.
The data also revealed that those women undergoing vaginal tightening (vaginoplasty) reported an estimated 82.2% overall improvement in their partner’s sexual satisfaction as well."
The fact that no one would ever even think of performing such a study on women in the US shows the true intentions of these researchers. My god imagine the shit storm that would ensue if anyone ever mentioned the words "labiaplasty" and "infant" in the same sentence.
I do find it funny how labiaplasties performed on babies is considered genital mutilation, but when performed on adult women is considered sexually enhancing plastic surgery.
Double standard anyone?
A remarkable display of indignation, Anonymous.
ReplyDeleteOf course, it is impossible to study everything, so it is perhaps a little unrealistic to complain so much that something hasn't been studied.
But please don't let me interrupt. ;-)
Of course not everything can be studied. But there have not been any studies performed on the genitalia of women.
ReplyDeleteI find this shocking given the many hypothesis of why male circumcision reduces the risk of HIV could easily be applied to the genitalia of women. Such as "One is by reducing the amount of mucosal tissue exposed during sex, which limits the viruses' access to the body cells they target." Those same cells that are in the male foreskin that are thought to increase their risk of contracting HIV are found in the female genitalia as well.
Surely if it was REALLY about saving lives SOMEONE would test these hypothesis. It's not like we are comparing earlobes to foreskin, here. Most tissues and organs are analogous in the male and female genitals.
But of course it would never happen. So much for saving lives...
Of course not everything can be studied. But there have not been any studies performed on the genitalia of women.
ReplyDeleteThere have been some, actually, studying UTIs (higher risk in women who have undergone FGC) and HIV (inconsistent results, but it seems safe to say that overall they indicate no effect or possible harm). For references, see: http://en.wikipedia.org/wiki/Female_genital_cutting#HIV
I find this shocking given the many hypothesis of why male circumcision reduces the risk of HIV could easily be applied to the genitalia of women. Such as "One is by reducing the amount of mucosal tissue exposed during sex, which limits the viruses' access to the body cells they target." Those same cells that are in the male foreskin that are thought to increase their risk of contracting HIV are found in the female genitalia as well.
See above.
The wiki you quoted demonstrates how little research has been done on the subject. It also links several studies that showed women who had been circumcised had lower HIV rates.
ReplyDelete"Relatively little research has been conducted on the effect female genital alteration may have on HIV prevalence.[44] Some studies have found increased risk of HIV among women who had undergone FGC.[45][46] Other studies have found no statistically significant associations,[47][48][49][50][51] or have identified more complex patterns.[52][53] Two studies have reported that FGC is associated with decreased risk of HIV.[54][55]"
"Stallings et al. (2009) reported that, in Tanzanian women, the risk of HIV among women who had undergone FGC was roughly half that of women who had not; the association remained significant after adjusting for region, household wealth, age, lifetime partners, union status, and recent ulcer. The authors, who expressed surprise at their finding, concluded that the association was due to confounding due to a further, unknown factor.[54]"
I love that last line, in particular. "The authors, who expressed surprise at their finding, concluded that the association was due to confounding due to a further, unknown factor." Of course no one would ever want to admit that cutting female genitalia might reduce their chance of getting HIV, because it is not socially acceptable. Wouldn't it be great if that sentence could have been added to the end of the African trials just as easily?
I think the mixed results of the very few studies clearly shows that more research needs to be done in this area.
The wiki you quoted demonstrates how little research has been done on the subject. It also links several studies that showed women who had been circumcised had lower HIV rates.
ReplyDeleteWell, two of the eleven studies found that result, so only through the most extreme cherry-picking could one conclude that FGC is protective.
I love that last line, in particular. "The authors, who expressed surprise at their finding, concluded that the association was due to confounding due to a further, unknown factor." Of course no one would ever want to admit that cutting female genitalia might reduce their chance of getting HIV, because it is not socially acceptable.
Look at it this way: if FGC is protective against HIV, then nine of eleven studies (82%) found the wrong result. That's possible, but it's not very likely. Stallings' conclusion was therefore the most likely explanation, given all of the research (including, but not limited to, theirs).
Wouldn't it be great if that sentence could have been added to the end of the African trials just as easily?
Um, no. Since the African trials were not observational studies, but instead were experimental RCTs, a design that is vastly more resistant to confounding, such a sentence would suggest that the author did not understand his/her own research. Furthermore, the RCTs would not have been conducted in the first place were it not for the fact that more than 40 observational studies had been performed previously, the majority of which found results consistent with a protective effect.
I think the mixed results of the very few studies clearly shows that more research needs to be done in this area.
I disagree: the results are exactly what I would expect to see if something truly had no effect: most studies find no statistically significant association, but a small and roughly (or in this case exactly) equal numbers of studies find apparent effects in both directions.
First of all, study 44 says "This mini-review aims to examine FGM and the possibility of HIV transmission through this procedure." Which is very different than testing to see whether female circumcision lowers the risk of HIV.
ReplyDeleteNext- study 45 says : " Conclusions: Parenteral transmission through ritual excision and multiple injections during treatment of tuberculosis and trypanosomiasis contributed to the emergence of HIV-2 in Guinea-Bissau." Again, parenteral transmission is not what we are looking for. A professional study would use sterile instruments, as would a hospital in the United States.
Study 46: "CONCLUSION: This study has demonstrated the extent of coinfection with HIV and HCV in The Gambia. The prevalence of female circumcision may be a contributory occurrence factor in the transmission of HIV but not in that of HCV." See above. Transmission.
I think it is safe to say better studies need to be carried out. There are many places in Africa where men are more likely to have HIV if they are circumcised. If we looked at that kind of anecdotal evidence alone it would be very misleading. A real study needs to be done that makes sure the higher rates of HIV in some circumcised women aren't because of in-sterile equipment.
Two of the ten studies were categorized as "have identified more complex patterns"
The science is far from established on this topic.
First of all, study 44 says "This mini-review aims to examine FGM and the possibility of HIV transmission through this procedure." Which is very different than testing to see whether female circumcision lowers the risk of HIV.
ReplyDeleteI agree, and that's why I excluded that from my analysis. Hence I counted 11 studies, rather than 12.
Next- study 45 says : " Conclusions: Parenteral transmission through ritual excision and multiple injections during treatment of tuberculosis and trypanosomiasis contributed to the emergence of HIV-2 in Guinea-Bissau." Again, parenteral transmission is not what we are looking for. A professional study would use sterile instruments, as would a hospital in the United States.
Of course, since the studies are observational, causality is not easy to determine. Here the authors speculate about what might explain their results. It is unclear, though, why you then use this speculative explanation as a basis for dismissing the study.
Study 46: "CONCLUSION: This study has demonstrated the extent of coinfection with HIV and HCV in The Gambia. The prevalence of female circumcision may be a contributory occurrence factor in the transmission of HIV but not in that of HCV." See above. Transmission.
Yes, see above.
I think it is safe to say better studies need to be carried out.
I don't see a pressing need.
There are many places in Africa where men are more likely to have HIV if they are circumcised.
It's true that some observational studies in Africa have found such a result, though they are in the minority.
If we looked at that kind of anecdotal evidence alone it would be very misleading. A real study needs to be done that makes sure the higher rates of HIV in some circumcised women aren't because of in-sterile equipment.
It would be unethical to conduct a randomised controlled trial, I'm afraid, since the overwhelming evidence indicates that FGC is harmful. So unfortunately observational studies will have to suffice.
"It would be unethical to conduct a randomised controlled trial, I'm afraid, since the overwhelming evidence indicates that FGC is harmful. So unfortunately observational studies will have to suffice."
ReplyDeleteFGC has been proven to be a very safe procedure here in the United States when performed by competent medical doctors and sterile equipment is used. I would even speculate it is safer than MGC in some ways, since surgeons here do not even put women under general anesthesia. Of course cutting off body parts with dirty equipment by local village elders has proven to be unsafe. There were articles that came out this summer showing the same thing for male circumcision. I think in the upwards of 20 boys died in one circumcision camp alone during the span of just one summer.
"What does the surgery involve?
It is actually similar to circumcision of the male penis. Like the penis the clitoris has a hood that can prevent required sensitivity in sexual intercourse. This operation is extremely delicate and the gynaecologist performing it is an expert with a great deal of experience. This is necessary because the clitoris has more nerve endings in it than in all the tissues surrounding it. The hood is either partially removed or split to allow the clitoris freedom to enlarge when you feel aroused. The procedure may be done with a laser.
Will there be complications?
The most serious complication may be infection. Excessive bleeding tends to occur when in ethnic cultures a non-medical person carries out this procedure. Because you will be attended to by a fully qualified and highly experienced surgeon, you should not experience any complications at all.
What can I expect from the surgery?
Good news! You should expect a rejuvenated sex life. Un-hooding your clitoris leads to increased stimulation and a noticeable increase in orgasms."
(http://www.gynaecologists.co.uk/clitoral_hoodectomy.html)
Doesn't sound so bad when it's put that way! I know this is only removal of the female foreskin, but labiaplasties and vaginoplasties done in the United States have also been shown to be very safe and result in positive sexual outcomes. ( As I have already shown in previous comments).
I think your claim of clitoral hood removal or labia removal being unsafe when performed in a sterile environment is unproven. Please don't start linking studies of women who had their vaginas sewn shut etc... of course that is not the kind of FGC we are talking about here. No removal of the clitoris.
As I said, the overwhelming evidence indicates that FGC is harmful. If you insist upon burying your head in the sand on this issue, that's up to you, but I fear it would be a waste of time to try to educate you on the subject.
ReplyDeleteYou're wrong. You are looking at evidence of surguries performed in third world countries. Labia surgury in the united states is extremely safe and is considered a minor procedure.
ReplyDeleteThe websites even claim a reduction in bacteria and yeast infections after labiaplasties. Less skin and moisture= less bacteria and infections.
Jake, I'd like to see the proof that FGC in developed countries is harmful. You're overstating the case with emotional words like "overwhelming", but I'm afraid you simply don't have the evidence. Genital cutting has the potential to be harmful, or even fatal, when it's practiced without proper methods or hygiene. Surely you know that hundreds of boys die every year throughout Africa? But that doesn't mean circumcision shouldn't be done.
ReplyDeleteAt the rate women are getting labiaplasty surgery it is estimated it will surpass breast augmentation surgery in a few years. It is the fastest growing cosmetic surgery in the united states and has already surpasses penis enlargement surgery.
ReplyDeleteThe results have been overwhelmingly positive and complications are rare. There has not been a single fatality in 10 years in the united states.
Jake, I'd like to see the proof that FGC in developed countries is harmful.
ReplyDeleteYes, I'd find that mildly interesting, too. However, we have to make the best of what information is available, and most studies of FGC have been performed in the developing world. I'm afraid I'm not going to find these studies for you; compared to circumcision, FGC is not a subject that I'm particularly interested in, and thus I'm unwilling to waste my time. However, I'm sure you can find them yourself without too much difficulty.
Jake wrote:
ReplyDelete"compared to circumcision, FGC is not a subject that I'm particularly interested in".
He can say that again!
And the same is true of all the other MGC advocates. It's a vicious circle. It doesn't get studied, benefits don't get found, it doesn't get promoted, it doesn't get studied. And I don't think that's a bad thing, because of the ethical issues, unless we're talking about adults freely making a decision for themselves, and with the genitals, that's rare. (It would make a lot of sense to find a way for women to protect themselves against HPV and hence reduce their own risk of cervical cancer. It would be much more direct and targetted than MGC, especially neonatal MGC.)
Meanwhile the same circle goes the other way with MGC: It does get studied, "benefits" get "found", it gets promoted, it gets studied.
We've currently got two news items doing the rounds about MGC. One (by advocate Ronald Gray) finds it protects against HPV, one (by some people in Hawaii, not among the usual advocates) finds it doesn't, but never mind, they've mined the data and found a benefit. Presto, more headlines.
compared to circumcision, FGC is not a subject that I'm particularly interested in".
ReplyDeleteHe can say that again!
And the same is true of all the other MGC advocates.
For future reference, I'd be grateful if you would not describe me as an "MGC advocate", nor a "circumcision advocate". I generally define myself as an opponent of the anti-circumcision lobby rather than a proponent of anything; what I advocate, if anything, is parental choice.
It's a vicious circle. It doesn't get studied, benefits don't get found, it doesn't get promoted, it doesn't get studied.
Except, as I pointed out above, it does get studied (or do you suppose those eleven studies are a figment of my imagination?).
But the results of those studies do not suggest a protective effect. That situation is very unlike that with circumcision, in which the earliest observational studies indicated a protective effect, and this was observed in most studies afterwards. So it should not be a surprise that further studies are performed: if something appears to work, it's going to receive more study than something that doesn't.
I'm sorry to disappoint, but there's no big, dark conspiracy going on. It's just science led by evidence and common sense.
Except of course it was impossible to determine in those rather small studies whether the women got HIV from the procedure or not, which is very likely.
ReplyDeleteExcept of course it was impossible to determine in those rather small studies whether the women got HIV from the procedure or not, which is very likely.
ReplyDeleteAre you suggesting that this is true of observational studies of FGC and HIV but not of observational studies of circumcision and HIV?
So what are you saying? If there had only been 11 studies and two out of eleven showed a protective effect and another two showed "complex patterns" and the rest didn't control for needle or instrument transmission that would have been the end of it? No one would pursue MGC further?
ReplyDeleteSomehow I find that hard to believe...
So what are you saying? If there had only been 11 studies and two out of eleven showed a protective effect and another two showed "complex patterns" and the rest didn't control for needle or instrument transmission that would have been the end of it? No one would pursue MGC further?
ReplyDeleteIf the evidence had suggested that there was no protective effect then it is unlikely that people would have bothered to study it further, yes. There is only a finite amount of money, resources, and brainpower in the world, and people tend not to waste time studying non-existent connections.
That wasn't the question
ReplyDeleteFor future reference, I'd be grateful if you would not describe me as an "MGC advocate", nor a "circumcision advocate".
ReplyDeleteI think many reasonable people, upon reading a good selection of your voluminous writing on circumcision, would rightly conclude that you are an advocate of circumcision, including neonatal circumcision. The fact that you have also done a good job countering some silly claims from some anti-circumcision writers can't undo your circumcision advocacy, which I am not going to recapitulate here, except to say that you clearly have crossed the line in professional writing from neutral observer to proponent.
Advocating "parental choice" for MGC but not for FGC is MGC advocacy. What would you call someone who advocated "parental choice" for foot-binding?
ReplyDeleteJake denies the clear evidence of such well-referenced histories as Glick's Marked in your Flesh and Darby's A Surgical Temptation that the orgin of secular circumcision lies in masturbation hysteria. He may have countered "some silly claims from some anti-circumcision writers" but he lets equally silly claims from pro-circumcision writers such as Morris, Weiss etc. go unchallenged. This very blog posited a connection between intactness and swine flu with no evidence whatsoever. Where was Jake?
"There is only a finite amount of money, resources, and brainpower in the world, and people tend not to waste time studying non-existent connections."
They have wasted plenty of time studying non-existent connections between MGC and a variety of maladies. Why the double standard?
Advocating "parental choice" for MGC but not for FGC is MGC advocacy. What would you call someone who advocated "parental choice" for foot-binding?
ReplyDeleteHow about "a person who believed in parental choice for foot-binding"? I'd disagree with such a person, but that would seem a poor basis for misrepresenting their position.
Jake denies the clear evidence of such well-referenced histories as Glick's Marked in your Flesh and Darby's A Surgical Temptation that the orgin of secular circumcision lies in masturbation hysteria.
Both Glick and Darby have strong ties to the anti-circumcision lobby, so it is unsurprising that they repeat such claims. Interestingly, more neutral historians (such as Gollaher) place very little weight on circumcision in the context of masturbation prevention. One of the problems with history as a discipline, of course, is that there is no scientific way to determine how much weight should be given to various sources, or how representative of typical views they might be. Hence the work can easily become a mirror for the historian's own biases.
He may have countered "some silly claims from some anti-circumcision writers" but he lets equally silly claims from pro-circumcision writers such as Morris, Weiss etc. go unchallenged. This very blog posited a connection between intactness and swine flu with no evidence whatsoever. Where was Jake?
Looking at the archive for that month (May 2009), it seems that Jake did not comment on any of the stories. In fact, I was unable to find any posts by Jake on this blog until July of that year, so I'd tentatively suggest that he hadn't discovered this blog at that time. :-)
They have wasted plenty of time studying non-existent connections between MGC and a variety of maladies. Why the double standard?
What double standard? Much of the research into circumcision has resulted in important results, and as such we now know that it is protective against multiple conditions.
I'd like the person who runs this blog to show his/her name and what university they're from. I think their hiding as they're a well-known circumcision zealot. Please show us who you are.
ReplyDeleteHuh? No matter what position you take, I don't think the author should have to divulge anything if doesn't want to, and clearly he doesn't. That's especially ripe coming from Anonymous!
ReplyDeleteBut back to the discussion at hand. Jake, do you seriously mean that, because of your pro-circumcision feelings, that you shouldn't be taken seriously? You mean your bias makes you suspect? That's what you are implying about Glick and Darby. This is a very strange position to take. Does your request not to be identified as a circumcision advocate relate to your desire to be taken seriously? Personally, I don't think that your circumcision advocacy - good grief, a guy who has 1000 circumcision papers in his personal library and has published papers on board with bonafide circumcision advocates is certainly an advocate - is any less believable than folks from the anti-circumcision crowd.
But back to the discussion at hand. Jake, do you seriously mean that, because of your pro-circumcision feelings, that you shouldn't be taken seriously? You mean your bias makes you suspect? That's what you are implying about Glick and Darby. This is a very strange position to take.
ReplyDeleteFirst of all, I don't have pro-circumcision feelings, but I do have pro-parental choice feelings, and yes, those are a source of bias.
Second, I don't, as a rule, have much to say on the topic of history - scientific subjects interest me more. It's not a subject that interests me especially, and I think it has only minimal relevance to the present day. But, hypothetically speaking, if I did decide to write a history of circumcision, I would expect my biases to affect my writing. Sure, I'd try to remain objective, but I'm only human, and have human weaknesses. In my (very possibly biased) opinion my biases are far fewer than those of Glick or Darby, because my views are less extreme, but even so it would be wholly unrealistic to imagine that only I were capable of unbiased historical analysis.
Finally, I don't think it really matters whether I'm taken seriously or not. I provide sources and logical arguments; wouldn't it make more sense to pay attention to those?
Does your request not to be identified as a circumcision advocate relate to your desire to be taken seriously? Personally, I don't think that your circumcision advocacy - good grief, a guy who has 1000 circumcision papers in his personal library and has published papers on board with bonafide circumcision advocates is certainly an advocate - is any less believable than folks from the anti-circumcision crowd.
Well, thank you for providing a concrete definition of an advocate, even though I disagree with it. :-)
But getting back to the "Circumcision speeds HPV clearance" study, a blogger called Cogito has pulled it apart:
ReplyDeleteJust the abstract alone raises a few red flags.
1: "There were no differences in HPV acquisition by circumcision status". So being circumcised doesn't change your risk of infection.
2. The statistic compared between the groups was the median duration, not the mean. Now it's possible that this branch of medical science has different standard tests, but in my experience the tests for statistical difference between groups always depends on the mean. Unless this type of research typically uses medians, the fact that the mean was not used raises the possibility that the desired result was not achieved when the mean was used.
3. The P value was 0.04. Even putting my general misgivings about statistical hypothesis testing aside, this result is only statistically significant at the .05 level, not the stricter .01 level usually used for work with medical implications.
But the problems get worse once you look at the actual paper (you'll probably need a university subscription to access the full text):
The duration of infection did not vary by circumcision status for the penile shaft, scrotum, or all genital sites combined... For the glans/coronal sulcus, the median duration of HPV infection was greater among uncircumcised men (154 days) than circumcised men (91 days), although the 95% CIs overlapped.
Read that again. If you didn't get it, I'll try to make it clear: If you consider only HPV on the penile shaft, only HPV on the scrotum, OR HPV across ALL GENITAL SITES, the duration of infection does not depend on circumcision status. It is only if you consider the glans alone that a longer infection duration is found (and the fact that the 95% confidence intervals overlapped just adds to the ridiculousness). One more time: When all genital sites are considered, the duration of infection does not depend on circumcision status. So being circumcised does not decrease your overall chance of infection, nor does it decrease the duration of an HPV infection at an arbitrary site. But wait, weren't we told differently in the abstract?
Circumcision may protect against HPV‐associated disease by enhancing the resolution of infection.
This is straight up intellectual dishonesty, and smacks of fitting the data to a pre-determined conclusion. The abstract claims the research to be a study about "the relationship between circumcision and the acquisition and clearance of human papillomavirus (HPV) infection" with no specification of where the HPV is located, and indeed HPV incidence and clearance was studied across all locations, and yet the only clearance-related result mentioned in the abstract pertains to a subset of the data, the glans/coronal sulcus data. If they really wanted to report the truth about the relationship, isn't the most important result the fact that, when all sites are considered, circumcision showed no effect on either infection or clearance?
Just the abstract alone raises a few red flags.
ReplyDelete1: "There were no differences in HPV acquisition by circumcision status". So being circumcised doesn't change your risk of infection.
It seems rather unwise to draw such a conclusion from a single study — after all, there have been a dozen or so observational studies of circumcision & HPV, as well as RCT data. Taken as a whole, meta-analysis of the literature shows strong evidence of a protective effect.
2. The statistic compared between the groups was the median duration, not the mean. Now it's possible that this branch of medical science has different standard tests, but in my experience the tests for statistical difference between groups always depends on the mean. Unless this type of research typically uses medians, the fact that the mean was not used raises the possibility that the desired result was not achieved when the mean was used.
I'm sorry to say this, but this comment comes across as rather paranoid. Different statisticians favour different statistics. Personally I'd use the mean, too, but speculating about foul play with no evidence is just irrational.
3. The P value was 0.04. Even putting my general misgivings about statistical hypothesis testing aside, this result is only statistically significant at the .05 level, not the stricter .01 level usually used for work with medical implications.
Alpha is traditionally set at 0.05 in medical papers, actually, though 0.01 is occasionally used. And really, "well, it is significant at this level but it wouldn't have been at a lower level" is not a very persuasive argument. It might be more honest to say "yes, it's significant, but I don't want to accept the result."
I won't comment about the full text, since I don't have a copy at the present time.
Jake, the author of the blog has replied to your comments on his blog. Go check it out.
ReplyDelete"HPV lasts longer in uncircumcised males"
ReplyDeleteApparently not for all males. A new study in the UK found that "Circumcision may protect gay men from the sexually transmitted infection syphilis, but a new study has found that the snip does not offer any protection from any other sexually transmitted infections like HIV, gonorrhoea, chlamydia or genital warts.
For the study, researchers at the University of New South Wales inspected 1,427 homosexual men, two-thirds of whom had been circumcised, over three years with regular testing for infections.
Their analysis showed that there was no association between infection and circumcision status for any disease excluding syphilis."
Mike. Please provide proof that you were cut at the age of 18 as you claim. A most unlikely prosepect.
ReplyDelete"Just a university academic"....this redudnacy suggests you think cleaning the bathrooms at the moody bible college counts. What is your doctorate in and where can we read what you have published. Until you respond with proof all will consider you a liar.
I am having an genital wart outbreak but I am schedule for a circumsion tomorrow....Should I cancel it until the genital wart dissappears?
ReplyDeletejust a damn yes or no would be great eh? read everything and it went from the concern of circumsize to prevent further break outs of genital warts to a rant about everything else..
DeleteSo yes or no to get circumzised to rid the damn things from coming back???
i was diagnose with human papillomavirus 4 years ago and i met a doctor he told me there is no cure and i have be taking some medication the warts multiplied when trying to removed them and it got me embarrass and pains. luckily few weeks ago i was recommend to Dr. Abu for a natural treatment after one week treatment i got 100% cure and all the wart disappeared. i sheared this post because its part of my life experience, encase anyone need speedy help about this cure email him at drabumerecurecentre@gmail.com
ReplyDeleteMy name is Rebecca Callahan 34 years old i contacted the Human papilloma virus infection/HPV,my husband left me because of this virus and i was unable to get birth,i was really passing through a lot because i tried every angles doctor prescribe to me yet nothing happened,i almost gave up on my life,on a faithful day i decided to check on the internet to see if there will be any means because i was really ready to spend my last cent on this my condition because i do believe my health is more important than anything.
ReplyDeleteDuring my research i saw a lady from Canada posted a link to a blog introducing Dr Abumere on how he helped her cure this virus through his natural organic medicine so i decided to give a tho i knew i tried every means,so i purchase the herbal medicine without wasting any time,i was using it as instructed,during the usage i start to notice my body is been release with the itch that i normally occur and i was very happy because it was embarrassing,after using the herbal medicine for three good weeks i decided to go for a test just as the doctor said and i discovered that i was no longer infected with this virus.
Here are the information to contact this doctor abumereherbalcentre@gmail.com OR http://abumereherbalcentre.com
It was during my research on HIV/Herpes that I stumbled upon the Hiv/Herpes information; information which is quite easy to find when doing a search for STD on google. I was into conspiracy at the time thought of HIV/Herpes Cured' being a conspiracy was something Ignorance though,I found pretty interesting about herbal medicine. I asked questions about the Herbal cure's on official HIV/Herpes websites and I was banned for doing so by moderators who told me that I was parroting Hiv/Herpes propaganda. This reinforced my belief that there is a cure for Hiv/Herpes Then i found a lady from germany name Achima Abelard Dr Itua Cure her Hiv so I send him a mail about my situation then talk more about it and send me his herbal medicine I drank for two weeks.And today I'm Cured no Hiv/Herpes in my life,I searched for Hiv/Herpes groups to attempt to make contact with people in order to learn more about Hiv/Herpes Herbal Cure's I believed at this time that you with the same disease this information is helpful to you and I wanted to do the best I could to spread this information in the hopes of helping other people.That Dr Itua Herbal Medicine makes me believes there is a hope for people suffering from,Parkinson's disease,Schizophrenia,Cancer,Scoliosis,Fibromyalgia,Fluoroquinolone Toxicity Syndrome Fibrodysplasia Ossificans Progressiva.Infertility, ,Epilepsy ,Diabetes ,Coeliac disease,,Arthritis,Amyotrophic Lateral Sclerosis,Alzheimer's disease,Adrenocortical carcinoma.Asthma,Allergic diseases.Hiv_ Aids,Herpes,Inflammatory bowel disease ,Copd,Diabetes,Hepatitis,I read about him online how he cure Tasha and Tara,Conley,Mckinney and many more suffrin from all kind of disease so i contacted him . He's a herbal doctor with a unique heart of God, Contact Emal..drituaherbalcenter@gmail.com Phone or whatsapp..+2348149277967.
ReplyDelete5 years ago I had warts, I was treated with some liquid applied to the warts they continued to grow and spread... The next 2 doctors did laser surgery to remove them. 1 year after the surgery, they grew back close to where the 1st ones were' so I was finally told it was hpv. I have had it for very long time, I contract it from my cheated boyfriend and I found out he was also infected and I end up the relationship between us. the warts was so embarrasses because it started spreading all over I have be dealing with this things for very long time the last treatment I take was About 2 years ago I applied natural treatment from Dr onokun herbal cure, a week after applying the treatment all the warts was gone. it's now 2 years and some months I don't have single wart or any symptoms of hpv. wow"" it's great, Dr onokun has finally cured me. Anyone living with hpv contact Dr onokun for natural treatment.
ReplyDeleteHis email address: dronokunherbalcure@gmail.com
I was diagnose with hpv virus i broke up with my boyfriend because i contracted the virus from him, luckily i found a herbalist name Dr. onokun everyone testify good of his natural treatment i picked up his address and contacted him. he truly treated me with natural herbs in a week and i got cured. i share this post because ever since i got this treatment I'm perfectly ok with my health. i contacted him through this email.. dronokunherbalcure@gmail.com
ReplyDeleteI am bold enough among many others to state that there is now a potent cure to this sickness but many are unaware of it. I discovered that I was infected with the virus 3 months ago, after a medical check-up. My doctor told me and I was shocked, confused and felt like my world has crumbled. I was dying slowly due to the announcement of my medical practitioner but he assured me that I could leave a normal life if I took my medications (as there was no medically known cure to Herpes). I went from churches to churches but soon found that my case needed urgent attention as I was growing lean due to fear of dying anytime soon. In a bid to look for a lasting solution to my predicament, I sought for solutions from the herbal world. I went online and searched for every powerful trado-medical practitioner that I could severe, cos I heard that the African Herbs had a cure to the Herpes syndrome. It was after a little time searching the web that I came across one Dr Itua(A powerful African Herbal Doctor), who offered to help me at a monetary fee. I had to comply as this was my final bus-stop to receiving a perfect healing. My last resolve was to take my life by myself, should this plan fail. At last it worked out well. He gave me some steps to follow and I meticulously carried out all his instructions. Last month, to be precise, I went back to the hospital to conduct another test and to my amazement, the results showed that negative,Dr Itua Can As Well Cure The Following Desease…Cancer,Hiv,Herpes, Hepatitis B,Liver Inflammatory,Diabetis,Fribroid,,Non Hodgkin Lymphoma,Skin Cancer,Uterine Cancer,Prostate Cancer Dercum,Infertility,fibromyalgia,Get Your Ex Back,Als,SYPHILLIS,Genetic disease,Epilepsy, Parkinson's disease..You can free yourself of this Herpes virus by consulting this great African Herbal Doctor via this e-mail: drituaherbalcenter@gmail.com or call and whatsapp him on +2348149277967 He will help you and his herb medication is sure. he has the cure on all disease .You can talk to me on INSTAGRAM..tashamoore219....
ReplyDeleteI'm 15 years old. I was born with HIV my mother passed away because of the HIV infection And I regret why i never met Dr Itua he could have cured my mum for me because as a single mother it was very hard for my mother I came across Dr itua healing words online about how he cure different disease in different races diseases like HIV/Aids Herpes,Parkison,Asthma,Autism,Copd,Epilepsy,Shingles,Cold Sore,Infertility, Chronic Fatigues Syndrome,Fibromyalgia,Love Spell,Prostate Cancer,Lung Cancer,Glaucoma.,psoriasis,Cirrhosis of Liver, Cataracts,Macular degeneration, Chrons disease,Infectious mononucleosis.,Cardiovascular disease,Lung disease.Enlarged prostate,Osteoporosis.Alzheimer's disease,psoriasis,Bipolar Disorder,Dementia.,Tach Disease,Breast Cancer,Blood Cancer,Colo-Rectal Cancer,Love Spell,Chronic Diarrhea,Ataxia,Arthritis,Amyotrophic Lateral Scoliosis,Fibromyalgia,Fluoroquinolone ToxicitySyndrome Fibrodysplasia Ossificans ProgresSclerosis,Weak Erection,Breast Enlargment,Penis Enlargment,Hpv,measles, tetanus, whooping cough, tuberculosis, polio and diphtheria)Diabetes Hepatitis even Cancer I was so excited but frighten at same time because I haven't come across such thing article online then I contacted Dr Itua on Mail drituaherbalcenter@gmail.com/ . I also chat with him on what's app +2348149277967 he tells me how it works then I tell him I want to proceed I paid him so swiftly Colorado post office I receive my herbal medicine within 4/5 working days he gave me guild lines to follow and here am I living healthy again can imagine how god use men to manifest his works am I writing in all articles online to spread the god work of Dr Itua Herbal Medicine,He's a Great Man.
ReplyDeleteThere are some natural remedies that can be used in the prevention and eliminate diabetes totally. However, the single most important aspect of a diabetes control plan is adopting a wholesome life style Inner Peace, Nutritious and Healthy Diet, and Regular Physical Exercise. A state of inner peace and self-contentment is essential to enjoying a good physical health and over all well-being. The inner peace and self contentment is a just a state of mind.People with diabetes diseases often use complementary and alternative medicine. I diagnosed diabetes in 2000. Was at work feeling unusually tired and sleepy. I borrowed a glucometer from a co-worker and tested at 760. Went immediately to my doctor and he gave me prescibtion like: Insulin ,Sulfonylureas,Thiazolidinediones but Icould not get the cure rather to reduce the pain abd brink back the pain again. I found a woman testimony name Comfort online how Dr Akhigbe cure her HIV and I aslo contacted the doctor and after I took his medication as instructed, I am now completely free from diabtes by doctor Akhigbe herbal medicine.So diabetes patients reading this testimony to contact his email drrealakhigbe@gmail.com or his Number +2348142454860 He also use his herbal herbs to diseases like:SPIDER BITE, SCHIZOPHRENIA, LUPUS,EXTERNAL INFECTION, COMMON COLD, JOINT PAIN, BODY PAIN, EPILEPSY,STROKE,TUBERCULOSIS ,STOMACH DISEASE. ECZEMA, PROGERIA, EATING DISORDER, LOWER RESPIRATORY INFECTION, DIABETICS,HERPES,HIV/AIDS, ;ALS, CANCER , MENINGITIS,HEPATITIS A AND B, THYROID, ASTHMA, HEART DISEASE, CHRONIC DISEASE. NAUSEA VOMITING OR DIARRHEA,KIDNEY DISEASE, WEAK ERECTION. EYE TWITCHING PAINFUL OR IRREGULAR MENSTRUATION.Dr Akhigbe is a good man and he heal any body that come to him. here is email drrealakhigbe@gmail.com and his Number +2349010754824
ReplyDeleteFor years, I have read and seen the advertisements in the mass media about all of the penis enhancement pills and thought that they were all scams or gimmicks. All of the medical sites that I have visited stated that none of the herbal supplements would ever help increase the size of a penis. I got very depressed when I read this, because unfortunately I was not naturally blessed with a penis that was big enough to arouse my sexual partner or past partners. I am a man that is past my sexual primetime and my sexual performance has a lot to be desired. I decided to try Doctoc Akhigbe herbal medicine after all the reading and researching that I have done.I saw a testimony " Joe" about doctror Akhigbe Herbal Medicine Since there is a Money Back Guarantee, I give him a trial what did I have to lose? I couldn't believe the results I was seeing after drinking the Natural Herbal Medicine and Herbal Soap to be rubign my penis! he sent to me through DHL courier delivery service . Within about 2 weeks I had a noticeable increase in the girth of my penis. Then after a coupleof aditional week it started to grow in length and I was amazed and very excited.before I finish the drink and the soap my penis had grown an additional two inches. I've had a considerable improvement with my sex life and these pills are certainly worth every penny I spent on them! I want to thank Dr Akhigbe for the time and effort they have spent on helping people in my situation.I know many are out there who are suffering this problem and they need help, email him. drrealakhigbe@gmail.com. He also cure other diseases like: . HIV/ AIDS. JOINT PAIN, BREAST ENLARGEMENT. DIABETIES. HERPES. AUTISM . NO PRIOD. CHRONIC DISEASES. LUPUS . MALE AND FEMALE FERTILITY. WAST & BACK PAIN. CANCER . DISCHARGE FROM BREAST PAIN, BREAST INFECTION. PARKINSON DISEASES. WOMEN SEXUAL PROBLEM. VAGINAL INFECTION. IRREGULAR MENSTRATION , PAIN & ITCHING, TOXOPLASMOSIS, . LOWER ABDOMINAL PAIN PAIN DURING SEX INSIDE THE PELVIC . PREMATURE EJACULATION. PAIN DURING URINATION. PELVIC INFLAMATORY DISEASES , VAGINAL DISCHARGE. (PID). PULMONARY FIBROSIS, DRIPPING OF SPERM FROM THE VAGINAL AS WELL AS FOR LOW SPERM COUNT. DENGUE, TUBERCULOSIS. CIRRHOSIS . ITCHING OF THE PRIVATE PART. ZERO SPERM COUNT. ASTHMA. . , EJACULATION. WEAK ERECTION. ERYSIPELAS, DISCHARGE FROM PENIS . HPV. QUICK EJACULATION. HEPATITIS A & B. STD. STAPHYLOCOCCUS + GONORRHEA + SYPHILIS. HEART DISEASE. PILE-HEMORRHOID. HIGH BLOOD PRESSURE. RHIUMATISM, THYROID, PENIS ENLARGEMENT . For your cure email him now: drrealakhigbe@gmail.com or Contact his numbe: +2349010754824.
ReplyDeleteGreat Dr. imoloa herbal medicine is the perfect cure for the HIV virus, I was diagnosed of HIV for 8 years, and every day I always looking for research to find the perfect way to get rid of this terrible disease because I always know that what we need because our health is on earth . So, on my internet search I saw several testimonies about how Dr. imoloa can cure HIV with powerful herbal medicines. I decided to contact this man, I contacted him for herbal medicines that I received via DHL courier service. And he guided me how. I asked him for a solution to take herbal medicine for two weeks. And then he instructed me to go check what I was doing. Look at me (HIV NEGATIVE). Thank God for Dr. Imoloa for using a powerful herbal remedy to cure me. he also has a cure for diseases such as Parkison's disease, vaginal cancer, epilepsy, anxiety disorders, autoimmune diseases, back pain, sprains, bipolar disorder, brain tumors, malignant, bruxism, bulimia, cervical disc disease, cardiovascular disease, cardiovascular disease, sprains, bipolar disorder, brain tumors, malignant, bruxism, bulimia, cervical disc disease, cardiovascular disease, cardiovascular disease, sprains, bipolar disorder, brain tumors, malignant, bruxism, bulimia, cervical disc disease, cardiovascular disease , chronic respiratory diseases, mental and behavioral disorders, Cystic Fibrosis, Hypertension, Diabetes, asthma, autoimmune mediated arthritis. Chronic kidney disease, arthritis, back pain, impotence, feta alcohol spectrum, Dysthymic Disorders, Eczema, skin cancer, tuberculosis, Chronic Fatigue Syndrome, constipation, inflammatory bowel disease, bone cancer, lung cancer, mouth sores, oral cancer, body pain, fever, hepatitis ABC, syphilis, diarrhea, Huntington's disease, back acne, chronic kidney failure, Addison's disease, Chronic Disease, Crohn's Disease, Cystic Fibrosis, Fibromyalgia, Inflammatory Bowel Disease, Fungal Nail Disease, Paralysis, Celia Disease , Lymphoma, Major Depression, Malignant Melanoma, Mania, Melorheostosis, Meniere's Disease, Mucopolysaccharidosis, Multiple Sclerosis, Muscle Dystrophy, Rheumatoid Arthritis, Alzheimer's Disease email- drimolaherbalmademedicine@gmail.com / or {whatssapp .....+2347081986098}
ReplyDeleteGood News My People ..I Want To Appreciate Dr OYAKHIRE Herbal Medicine Is A Good Herbal Medicine For( HIV ),I Was Diagnosed With Hiv
ReplyDeleteVirus Last Month,And i Looked For Solution To
Be Cure,Luckily I Saw A Testimonies On How Dr
OYAKHIRE Cured Hiv Virus,I Decided To Contact Dr OYAKHIRE ,I Contacted Him and He Prepared A Herbal Medicine Portion And Sent It To Me,I Started The Herbal Medicine For My Health,He Gave Me Step By Step Instructions On How To Apply It, When I Applied It As Instructed, I Was Cured Of This Deadly HIV Virus Within 1week, I Am Now Hiv Negative.My Brothers And Sisters I
know That There Are So Many People That Have
this Same HIV Virus Please Dr OYAKHIRE is here To Help you too,And please Help Me To Thank Dr OYAKHIRE For Curing Me, I’m Cured By Dr.OYAKHIRE Herbal Medicine,His Contact you can whatapps him on is phone number okay
here is the number on Whatsapp,
(+2349039208180 or email droyakhire7@gmail.com
(1) HIV / AIDS
(2) CANCER
(3) HERPES
(4) DIABETES
(5) HERPERTITIS B
(6) HPV
(7)EX BACK
(8)Tinnitus
(9) stroke
(10) asthma
(11) fibroid
I am here to give my testimony about Dr Anuge who helped me.. i want to inform the public how i was cured from (HERPES SIMPLEX VIRUS) by Dr Anuge, i visited different hospital but they gave me list of drugs like Famvir, Zovirax, and Valtrex which is very expensive to treat the symptoms and never cured me. I was browsing through the Internet searching for remedy on HERPES and i saw comment of people talking about how Dr anuge cured them. when i contacted him he gave me hope and send a Herbal medicine to me that i took for just 2 weeks and it seriously worked for me, my HERPES result came out negative. I am so happy as i am sharing this testimony. My advice to you all who thinks that there is no cure for herpes that is Not true just contact him and get cure from Dr Anuge healing herbal cure of all kinds of sickness you may have like
ReplyDelete(1) CANCER,
(2) DIABETES,
(3) HIV&AIDS,
(4) URINARY TRACT INFECTION,
(5) CANCER,
(6) IMPOTENCE,
(7) BARENESS/INFERTILITY
(8) DIARRHEA
(9) ASTHMA
(10)SIMPLEX HERPES AND GENITAL
(11)COLD SORE
and mare that are not mentioned here
. he also cure my friend from cervical cancer. so contact him thruogh his Email address : dranuge@gmail.com or whatsapp him on +234816466838 here is also his IG link @Dr_Anuge7 for more information ........
God bless Dr. Omolowa for his marvelous work in my life, I was diagnosed of HERPES since 2018 and I was taking my medications, I wasn't satisfied i needed to get the HERPES out of my system, I searched out some possible cure for HERPES i saw a comment about Dr. Omolowa, how he cured HERPES,DIABETES,HIV,and CANCER with his herbal medicine, I contacted him and he guided me. I asked for solutions, he started the remedy for my health, he sent me the medicine I took the medicine as prescribed by him and 14 days later i was cured from HERPES, Dr. Omolowa truly you are great, do you need his help also? Why don’t you contact him through his EMAIL: dr.omolowa@gmail.com call or whatsApp him on +2347014035034
ReplyDeleteI'm giving a testimony about Dr Nogadu the great Herbalist, he has the cure to all manner of diseases, he cured my herpes simplex virus, though I went through different website I saw different testimonies about different spell casters and herbalist, I was like: 'Many people's have the herpes simplex virus cure why are people still suffering from it?' I though of it, then I contact Dr Nogadu via email, I didn't believe him that much, I just wanted to give him a try, he replied my mail and Needed some Information about me, then I sent them to him, he prepared it (CURE) and sent it to me through Air freight Online Courier Service for delivery, he gave my details to the Courier Office, they told me that 2-4 days I will receive the parcel and i took the medicine as prescribed by him and I went for check up 2 week after finishing the medicine, I was tested herpes simplex virus negative, if you are herpes simplex virus patient do me a favour by contacting him and I assure anyone who is suffering from it, your problem will never remain the same again you will be cured also Dr Nogadu help my brother wife to cure her cervical cancer she was suffering from the past 5 years, After he {cure} my herpes simplex virus, then my brother heard about it, he went home to tell his wife about Dr Nogadu then his wife email him and explain her problem to him, he also prepare herbal medicine and he use Air freight courier service to sent her the herbal medicine and he instruct her on how she will be using it for 14 days, That on the 15 days of it, she should go and check her self in the hospital and she did as she was instructed by Dr Nogadu, to GOD be the glory she was cure of her cervical cancer which she was suffering from for the past 5 years thanks to these great man we will ever remain grateful to you sir for the good work you did in our family. When you contact him, make sure you tell him that I refer you.. contact him via: drnogaduherbalist@gmail.com or WhatsApp him on +2347010627760.
ReplyDelete