Association between male circumcision and human papillomavirus infection in males and females: a systematic review, meta-analysis, and meta-regression
Notice bibliographique
Résumé
ABSTRACT Background Human papillomavirus (HPV) infection is a necessary cause of cervical cancer and is associated with anal, penile, vaginal, and vulvar cancers. Previous studies have suggested a protective effect of male circumcision (MC) on HPV infections in males, and that this protection may be conferred to their female sexual partners. We synthesized the available evidence on the association between MC and HPV infections in males and females. Methods We performed a systematic review and meta-analysis of the effect of MC on the prevalence, incidence, and clearance of genital HPV infections in heterosexual males and their female sexual partners. We searched multiple databases for studies that assessed MC status and tested for the presence of genital HPV DNA. We used random-effects meta-analysis models to estimate summary measures of effect and 95% confidence intervals (CI) for the prevalence, incidence, and clearance of HPV infections in males and females. We assessed effect modification for prevalence in males using random-effects meta-regression. Findings We included 32 publications encompassing 25 unique study populations. MC was associated with decreased odds of prevalent HPV infections (odds ratio 0·45, CI 0·34–0·61), a reduced rate of incident HPV infections (incidence rate ratio 0·69, CI 0·57–0·83), and an increased risk of clearing HPV infections (risk ratio 1·44, CI 1·28–1·61) at the glans penis. Effect modification by sampling site was observed for HPV prevalence in males, with greater protection conferred by MC at the glans than the shaft (OR 0·68, 95% CI 0·48–0·98). Females with circumcised sexual partners were at reduced risk for all outcomes. Interpretation MC protects against various HPV infection outcomes, especially at the glans, and may be a viable prophylactic strategy in regions with a high burden of HPV-associated disease where the HPV vaccine is not commercially available. That the protective effect of MC on HPV infection prevalence varies by penile site has important implications for epidemiologic studies of HPV transmission. Funding Funded by grant FDN-143347 from the Canadian Institutes of Health Research. RESEARCH IN CONTEXT Evidence before this study Previous meta-analyses published in 2011, 2012, and 2017 have assessed the impact of MC on genital HPV infections in males, while systematic reviews published in 2017 and 2019 have described the impact of MC on women’s sexual health outcomes. All meta-analyses of males found a protective effect of MC on HPV prevalence, with inconsistent evidence for the association between MC and HPV incidence and clearance. Systematic reviews in females found a protective effect of MC on HPV prevalence. Added value of this study We identified an additional 12 publications (including one randomized controlled trial) that were not included in the most recently published systematic review and meta-analysis. We found that in males, MC conferred protection against prevalent HPV infections at the glans and shaft of the penis, protected against the acquisition of HPV infections at the glans, and resulted in increased clearance of HPV infections at the glans and shaft. We also found that MC protected females against various HPV infection outcomes. We considered anatomical site in all analyses and explored effect modification using a meta-regression approach. Our meta-analysis also examined the impact of MC on various HPV infection outcomes in females. To our knowledge, the latter two types of analyses had not been done before. Implications of all the available evidence Countries with a high burden of HPV-associated diseases, or where the HPV vaccine is not commercially available, may wish to consider male circumcision as a preventive strategy. Both males and their female sexual partners may benefit from MC for protection from HPV infections.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,012 | 0,032 |
| Méta-épidémiologie (sens strict) | 0,003 | 0,002 |
| Méta-épidémiologie (sens large) | 0,021 | 0,045 |
| Bibliométrie | 0,005 | 0,007 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,003 | 0,002 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».