Doctors should start telling sexually active teenage boys who aren’t circumcised that if they have the surgery, they can reduce their risk of contracting HIV and other sexually transmitted infections from their female partners, federal health officials propose.
Similar counselling is urged for adult heterosexual men who remain uncircumcised and for expectant parents who will be making a decision about newborn circumcision if they have a boy, according to the new recommendations, proposed by the Centers for Disease Control and Prevention.
Most American boys are circumcised as newborns, but the percentage of parents having their infants circumcised in hospitals has fallen in recent years, even as evidence from African studies suggests that it may be protective. Circumcision has also come under fire, in part because babies cannot give their consent to the operation, with some critics saying the practice constitutes genital mutilation.
The draft of the recommendations, which will undergo peer review and be subject to public comments for 45 days before being finalised, note that teenage boys should be counselled along with their parents and have a say in the decision-making process, an element that may neutralise some opposition.
“Our role is to provide accurate information so people can make informed decisions,” said Dr Jonathan Mermin, director of the National Center for HIV/AIDS at the CDC. “The first thing that is important to know is that male circumcision has been associated with a 50 to 60 percent reduction of HIV transmission, as well as a reduction in sexually transmitted infections such as herpes, bacterial vaginosis and the human papilloma virus (HPV), which causes penile and cervical cancer,” Dr Mermin said.
He emphasised, however, that circumcision did not entirely eliminate the risk of infections, and circumcised men must continue to take other precautions, such as using condoms and limiting sexual partners.
Whether teenage American boys or men will be persuaded to go under the knife is another question.
The CDC’s own background report summarising the scientific evidence cited a consumer study that found that only 10 per cent of 709 heterosexual uncircumcised adult men said that they were “likely” or “very likely” to undergo circumcision, even if told it would reduce their risk of HIV. More than 80 per cent said they were “unlikely” or “very unlikely” to undergo circumcision.
“It’s hard to imagine very many adolescents deciding to have a circumcision done,” said Dr Douglas S Diekema, a member of the American Academy of Pediatrics’ task force on circumcision.
While older adults may be more likely to opt for circumcision especially if they engage in a lot of risky sexual behavior, Dr Diekema said, “It’s a difficult thing to get the adolescent brain to make that kind of calculation.” The conversation itself may also be awkward for health care providers and their young patients, he said.