(b) Svare et al. (2002) [54]: Copenhagen, Sweden, STI clinic
Site
HPV
Circumcised
Uncircumcised
()
()
AOR (95% CI)
Glans, coronal sulcus,
Shaft, scrotum
Any HPV
9%
21%
0.20 (0.06β0.60)
(c) Baldwin et al. (2004) [44]: Tucson, Arizona, STI clinic, 42% white (non-Hispanic), 39% Hispanic, 19% indigenous, Pacific Islander or Asian, age 18β70, 90% heterosexual, 82% single, condom users had 79% lower high-risk HPV and 42% higher low-risk HPV
(e) Shin et al. (2004) [52]: South Korea, university students, 46% had β₯4 sex partners
Site
HPV
Circumcised
Uncircumcised
()
()
OR (95% CI)
Coronal sulcus, meatus,
shaft, scrotum
Any HPV
7.0%
8.9%
1.8 (0.4β8.2; NS)
(f) Lajous et al. (2005) [48]: Mexico City, soldiers, age 16β40 (av. 23), average 3 sex partners. condom use with prostitutes did not affect HPV prevalence
Site
HPV
Circumcised
Uncircumcised
()
()
AOR (95% CI)
Coronal sulcus, meatus,
shaft, scrotum
Any HPV
29.5%
44.0%
0.48 (0.30β0.77)
(g) Vaccarella et al. (2006) [57]: Mexico, 27 public vasectomy clinics in 14 states, average age 34 years, HPV was 60% less for condom users with regular partners and 90% less with sex workers, high-risk and low-risk HPV stated as similar within each of circumcised and uncircumcised
Site
HPV
Circumcised
Uncircumcised
()
()
AOR (95% CI)
Glans/coronal sulcus,
Meatus, shaft, scrotum
Any HPV
2.4%
11.7%
0.20 (0.10β0.40)
(h) Partridge et al. (2007) [51]: Seattle, university students, age 18β20, white 85%, Asian/Pacific Islander 8.3%, other 7.1%, unmarried
Site
HPV
Circumcised
Uncircumcised
()
()
HR (95% CI)
Glans, shaft, scrotum
1.2/100PY
1.7/100PY
1.1 (0.6β2.0; NS)
(i) Hernandez et al. (2008) [59]: Hawaii, university population, most white, single, average age 29, 77% heterosexual, 53% had had β₯6 female sex partners, 50% used condoms, all HIV-negative
Site
HPV
Circumcised
Uncircumcised
()
()
AOR (95% CI)
Glans/coronal sulcus
Any HPV
29%
46%
0.51 (0.27β0.97)
High-risk
16%
31%
0.40 (0.18β0.90)
Low-risk
22%
39%
0.51 (0.25β1.08)
Multiple
12%
39%
0.28 (0.12β0.67)
Shaft
Any HPV
50%
60%
0.63 (0.42β1.22)
High-risk
34%
38%
0.70 (0.32β1.52)
Low-risk
45%
56%
0.59 (0.30β1.16)
Multiple
30%
36%
0.57 (0.26β1.28)
Urine
Any HPV
8%
16%
0.31 (0.08β1.16)
High-risk
1%
3%
0.18 (0.004β7.69)
Low-risk
7%
16%
0.28 (0.07β1.10)
Multiple
1%
0%
β
Semen
Any HPV
6%
5%
1.09 (0.17β7.14)
High-risk
2%
0%
β
Low-risk
6%
5%
0.86 (0.13β5.88)
Multiple
1%
0%
β
Scrotum
Any HPV
40%
40%
0.82 (0.43β25.0)
High-risk
20%
20%
0.69 (0.33β2.38)
Low-risk
33%
35%
0.69 (0.33β1.43)
Multiple
14%
19%
0.53 (0.21β1.33)
External penis
Any HPV
57%
67%
0.58 (0.30β1.14)
High-risk
25%
23%
0.82 (0.28β2.38)
Low-risk
30%
36%
0.61 (0.25β1.47)
Any
20%
23%
0.52 (0.17β1.56)
Any site
Any HPV
78%
83%
0.49 (0.19β1.28)
High-risk
55%
58%
0.38 (0.11β1.28)
Low-risk
61%
67%
0.42 (0.14β1.25)
Multiple
39%
41%
0.35 (0.09β1.43)
(j) Nielson et al. (2009) [49]: Tucson and Tampa, aged 18β40, circumcised participants: white 76%, Indigenous 6%, black 1%, Asian/Pacific Islander 2%, other 4%; >6 sex partners 65%, condom use β€ half = 56%, sex with partner with abnormal pap smear 26% for circumcised, 11% for uncircumcised
Site
HPV
Circumcised
Uncircumcised
()
()
AOR (95% CI)
Glans/coronal sulcus
Any HPV
29.8%
35.2%
0.44 (0.23β0.82)
High-risk
13.9%
18.3%
0.47 (0.22β0.99)
Low-risk
15.8%
16.9%
0.62 (0.29β1.29)
Shaft
Any HPV
40.2%
40.9%
0.53 (0.28β0.99)
High-risk
21.2%
25.4%
0.50 (0.25β1.00)
Low-risk
19.1%
15.9%
0.85 (0.40β1.80)
Scrotum
Any HPV
25.9%
24.3%
0.73 (0.37β1.44)
High-risk
12.9%
12.9%
0.68 (0.29β2.06)
Low-risk
12.9%
11.4%
0.86 (0.36β2.06)
Urethra
Any HPV
7.8%
14.9%
0.17 (0.05β0.56)
High-risk
3.9%
2.1%
1.24 (0.14β10.8)
Low-risk
3.9%
12.8%
0.04 (0.01β0.23)
Semen
Any HPV
4.2%
7.1%
0.48 (0.12β1.96)
High-risk
3.1%
3.6%
0.41 (0.10β2.78)
Low-risk
1.1%
3.6%
0.41 (0.03β5.07)
Any site
Any HPV
51.2%
51.4%
0.53 (0.28β0.99)
High-risk
28.8%
31.2%
0.56 (0.30β1.06)
Low-risk
22.4%
20.3%
0.84 (0.43β1.67)
(k) Giuliano et al. (2009) [46]: USA (34%), Mexico (32%), Brazil (35%); age 18β70 (av. 32), 66% had >1 sex partner in past 3 months, 9% had had sex with male, condom use: always 20%, sometimes 32%. The respective OR became 0.70 (0.52β0.94), 0.70 (0.50β0.97), and 0.63 (0.42β0.93) after multivariate analysis
Site
HPV
Circumcised
Uncircumcised
()
()
OR (95% CI)
Coronal sulcus, shaft, under foreskin, scrotum (all Ξ²-globin DNA-positive)
Any HPV
54.8%
62.2%
0.97 (0.68β1.39)
High-risk
41.8%
49.2%
0.93 (0.63β1.33)
Low-risk
33.1%
40.4%
1.15 (0.74β1.79)
(l) Auvert et al. (2009) [43]: RCT, South Africa, Black, age 18β24, average 4 lifetime sex partners, consistent condom use 25%, 5% HIV-positive
Site
HPV
Circumcised
Uncircumcised
(643)
(621)
PRR (95% CI)
Urethra
High-risk
14.0%
23.2%
0.60 (0.46β0.79)
Multiple high-risk
4.2%
9.9%
0.43 (0.28β0.66)
(m) Tobian et al. (2009) [55]: Rakai 1 RCT, Kenya; age 15β49 years; only Ξ²-globin positive samples
Site
HPV
Circumcised
Uncircumcised
()
()
RR (95% CI)
Glans/coronal sulcus
All HPV
35.6%
51.2%
0.70 (0.53β0.91)
High-risk
18.0%
27.9%
0.65 (0.46β0.90)
Low-risk
26.2%
39.4%
0.66 (0.49β0.91)
Multiple
4.3%
12.2%
0.35 (0.17β0.71)
(n) Gray et al. (2010) [47]: Rakai, Uganda; RCT; age 15β24 (22%), 25β35 (51%), >35 (26%); condom use (35%), >1 sex partners 42%; HPV at enrolment (39%); data for 24 months: after circumcision
Site
HPV
Circumcised
Uncircumcised
()
()
IRR (95% CI)
Glans/coronal sulcus
Any high-risk HPV
19.7%
29.4%
0.67 (0.50β0.90)
Single new high-risk HPV
12.9%
15.6%
0.89 (0.60β1.30)
Multiple new high-risk HPV
6.7%
14.8%
0.45 (0.28β0.73)
HPV16
3.6/100PYs
4.8/100PYs
0.75 (0.38β1.51)
HPV18
1.6/100PYs
5.3/100PYs
0.30 (0.12β0.75)
HPV31
1.6/100PYs
2.2/100PYs
0.74 (0.27β2.05)
HPV33
0.5/100PYs
3.1/100PYs
0.17 (0.04β0.76)
HPV35
1.9/100PYs
3.7/100PYs
0.50 (0.21β1.21)
(Condom use)
22/100PYs
32/100PYs
0.68 (0.43β1.09)
(o) Tobian et al. (2011) [56]: Rakai, rural Uganda, RCT, age 15β49, consistent condom use 16%, HPV test at 12 months after circumcision, only Ξ²-globin DNA positive samples included, high-risk HPV significantly higher on coronal sulcus than on shaft
Site
HPV
Circumcised
Uncircumcised
()
()
APR (95% CI)
Coronal sulcus
Any high-risk HPV
21.5%
36.3%
0.57 (0.39β0.84)
Multiple high-risk
7.4%
10.5%
0.71 (0.33β1.52)
Shaft
Any high-risk HPV
15.5%
23.8%
0.66 (0.39β1.12)
Multiple high-risk HPV
1.7%
3.8%
0.45 (0.09β2.27)
OR: odds ratio; AOR: adjusted odds ratio; NS: not significant; RR: risk ratio; PPR: prevalence risk ratio; HR: hazard ratio, 100PY: 100 person years.