Prevention of sexually transmitted infections (STIs)
Male circumcision reduces the prevalence of HPV infection in males and herpes simplex virus type-2 transmission.1,8 According to the American Academy of Pediatrics, the evidence for male circumcision in the protection against syphilis is less strong and the risk of gonorrhea or Chlamydia is not decreased in circumcised males.8 Contradictory, the WHO states that there is a reduced risk of syphilis and gonorrhea among circumcised men and a significantly reduced risk of Chlamydia in the female partners of circumcised men. In the industrialized world, routine circumcision is not recommended by national pediatric societies for the prevention of these conditions, as the risks are judged to outweigh the benefits of the procedure.
Circumcision can protect men from acquiring HIV trough heterosexual intercourse. In Southern Africa, the region of the world with the highest incidence of HIV infections, this procedure will likely be integrated in the WHO package of HIV prevention measures. In this region the acquisition of HIV is mainly trough heterosexual sexual contact. The current prevention strategies include the promotion of abstinence, delayed sexual debut in young people, fidelity, reduction in the number of partners and correct condom use. It must be clearly stated that male circumcision does not provide complete protection against HIV. The other prevention practices must still be followed. This message may be difficult to communicate and risky behavior may increase in circumcised men.1 In Western countries, the prevalence of HIV infections is much lower and the acquisition of HIV is mainly trough homosexual contact.15 According to the centers for disease control (CDC), newborn circumcision performed in the United States of America is cost effective for the prevention of HIV infection.8 The Royal Dutch Medical Association (a.k.a KNMG) refutes this. The incidence of circumcision is much lower in The Netherlands than in the United States of America and the number of HIV infections is much lower, thus the promotion of safe sex is a better prevention strategy.16