Wednesday, April 14, 2010

HPV Last Longer in Uncircumcised Males

The evidence keeps adding up for all males to shed that disease-entrapping foreskin as soon after birth as possible. This latest study comes from the May 2010 edition of the Journal of Infectious Diseases, as reported by Reuters Health news service today.

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.

"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."

38 comments:

  1. Here is an exert from a more detailed article discussing the same study :

    "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.

    ReplyDelete
  2. And 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.

    ReplyDelete
  3. Hugh, 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.

    ReplyDelete
  4. 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. :-)

    ReplyDelete
  5. "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. :-)"

    If 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?

    ReplyDelete
  6. A remarkable display of indignation, Anonymous.

    Of 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. ;-)

    ReplyDelete
  7. Of course not everything can be studied. But there have not been any studies performed on the genitalia of women.

    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.

    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...

    ReplyDelete
  8. Of course not everything can be studied. But there have not been any studies performed on the genitalia of women.

    There 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.

    ReplyDelete
  9. 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.

    "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.

    ReplyDelete
  10. 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.

    Well, 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.

    ReplyDelete
  11. 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.

    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.

    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.

    ReplyDelete
  12. 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.

    I 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.

    ReplyDelete
  13. "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."

    FGC 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.

    ReplyDelete
  14. 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.

    ReplyDelete
  15. You'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.

    The websites even claim a reduction in bacteria and yeast infections after labiaplasties. Less skin and moisture= less bacteria and infections.

    ReplyDelete
  16. 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.

    ReplyDelete
  17. At 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.

    The results have been overwhelmingly positive and complications are rare. There has not been a single fatality in 10 years in the united states.

    ReplyDelete
  18. Jake, I'd like to see the proof that FGC in developed countries is harmful.

    Yes, 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.

    ReplyDelete
  19. Jake wrote:
    "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.

    ReplyDelete
  20. 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.


    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.

    ReplyDelete
  21. 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.

    ReplyDelete
  22. 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.

    Are you suggesting that this is true of observational studies of FGC and HIV but not of observational studies of circumcision and HIV?

    ReplyDelete
  23. 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?

    Somehow I find that hard to believe...

    ReplyDelete
  24. 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?

    If 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.

    ReplyDelete
  25. That wasn't the question

    ReplyDelete
  26. For future reference, I'd be grateful if you would not describe me as an "MGC advocate", nor a "circumcision advocate".

    I 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.

    ReplyDelete
  27. Advocating "parental choice" for MGC but not for FGC is MGC advocacy. What would you call someone who advocated "parental choice" for foot-binding?

    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. 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?

    ReplyDelete
  28. Advocating "parental choice" for MGC but not for FGC is MGC advocacy. What would you call someone who advocated "parental choice" for foot-binding?

    How 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.

    ReplyDelete
  29. 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.

    ReplyDelete
  30. Huh? 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!

    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. 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.

    ReplyDelete
  31. 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.

    First 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. :-)

    ReplyDelete
  32. But getting back to the "Circumcision speeds HPV clearance" study, a blogger called Cogito has pulled it apart:

    Just 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?

    ReplyDelete
  33. Just 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.


    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.

    ReplyDelete
  34. Jake, the author of the blog has replied to your comments on his blog. Go check it out.

    ReplyDelete
  35. "HPV lasts longer in uncircumcised males"

    Apparently 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."

    ReplyDelete
  36. Mike. Please provide proof that you were cut at the age of 18 as you claim. A most unlikely prosepect.
    "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.

    ReplyDelete
  37. I am having an genital wart outbreak but I am schedule for a circumsion tomorrow....Should I cancel it until the genital wart dissappears?

    ReplyDelete
    Replies
    1. just 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..
      So yes or no to get circumzised to rid the damn things from coming back???

      Delete