割包皮狀態不會影響婦女的性病風險


  August 7, 2007 (西雅圖) — 男性割包皮 (MC)可以減少其感染HIV的風險,而新的證據 — 三項最近的隨機控制試驗和觀察研究的分數— 支持這項已經大量運用外科手術所進行的預防方式;不過,較鮮為人知的是,MC是否可以減少婦女的非HIV類性病(STIs) ;國際性病研討會第17屆年會中所發表的一篇新研究指出, 男性割包皮的保護效果不會轉移到其女性性伴侶,也就是STI風險不會因此減少。
  
  這個多中心研究分析一項前溯式世代研究( HC-HIV 研究)的5,925位非洲和泰國女性資料,探索荷爾蒙避孕法和HIV或者STI之間的關聯,發現 MC 不會顯著降低婦女的淋病、滴蟲、披衣菌感染風險。
  
  共同作者,北加州大學醫學副教授William C. Miller表示,另一半有割包皮的婦女,與另一半沒有割包皮的婦女之間,STI發生率只有一些不同— 所以我們結論認為割包皮對此一族群實在沒有效果;他指出,也沒有確切證據支持MC可以保護男性免於研究中的這三種STIs,儘管男性包皮為病原菌生長的「好客」環境是眾所皆知的事情。
  
  此研究之研究對象是低STI風險的婦女(平均年紀25歲),參與者在開始時以及每3個月接受臨床檢查和取樣,為期15到24個月;整體來說,52%參與者的另一半有割包皮,87%與另一半同居,招募參加研究時僅有9 位婦女有STI。
  
  終點時,另一半有割包皮的婦女,每100人年(PY)披衣菌發生率是4.5, 另一半沒有割包皮的婦女,每100 PY披衣菌發生率是3.9;淋病方面,兩組的結果分別是 3.7 和 3.1;滴蟲方面,兩組的結果分別是4.7 和3.9。
  
  在多變項分析中,控制避孕方式、年紀、初次性行為年紀、國家、校正危害比(HR)之後,比較另一半有割包皮的婦女與另一半沒有割包皮的婦女,披衣菌感染是1.22 ,淋病感染是 0.93;有趣的是,僅有一位性伴侶的婦女之中,另一半有割包皮的婦女,其披衣菌風險還比較高 (1.01 vs 1.75; HR, 1.33)。
  
  華盛頓大學AIDS與性病中心主任King Holmes博士表示,整體來說,研究發現不令人感到意外,但他們確實指出需要長期研究;此研究是有趣的,但重點是披衣菌和淋病是包含在尿道而不是陰莖上皮,所以他們不是受男性割包皮影響的疾病元兇,除非是軟性下疳(Chancroid)、疱疹(Herpes)、梅毒(Syphilis),我認為問題依然存在,男性割包皮是否與增加陰道細菌增生症(Bacterial Vaginosis)風險有關 — 有些資料顯示另一半沒有割包皮的婦女其風險增加。
  
  Miller醫師指出研究限制,特別是次級資料和自我報告的性行為資料的可信度,他也指出,雖然MC在全球被用來阻斷HIV傳播,但男性割包皮對婦女STI風險的效果仍未知。
  
  Miller醫師和Holmes醫師報告沒有相關財金關係。
  
  國際性病研討會第17屆年會:摘要 449。發表於2007年7月30日。

Circumcision Status Does Not A

By Bonnie Darves
Medscape Medical News

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

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

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

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

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

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

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

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

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

    
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