Routine male neonatal circumcision and risk of infection with HIV-1 and other sexually transmitted diseases

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Abstract
Routine neonatal male circumcision as policy excites strong medical opinions both for and against. In the USA over 70% of all males have been circumcised1 while the UK’s national survey of sexual attitudes and lifestyles found in 1990/1 that 21% of adult males (aged 16–59 years) reported having been circumcised.2 The percentage was 13% among those aged 16–24 years but 32% for those 45–59 years indicating that British rates have declined recently,2 as they may also have done in the USA.3 Circumcision rates are intermediate in Canada1 but very low in the Nordic countries.4 These large intercountry differences are not explicable on religious grounds.1 2 They are best explained on grounds of medico/social culture and fashion, as is the case for some other elective surgical procedures of uncertain effectiveness.1 5 The case for routine male circumcision has rested most firmly on the observation that rates of infant urinary tract infection and adult penile cancer are lower in circumcised males.6 However when weighed against the irreducible complication rates and costs of the procedure, these are thought insufficient grounds to recommend routine circumcision.1 3 7 Recently added is the observation that circumcised males seem less likely to acquire infection with HIV-1, or other …