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Andrew B. Kairalla MD, Editor
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Should AAP endorse Circumcisions?
Dickerman JD. Circumcision in the Time of HIV: When Is There Enough Evidence to Revise the American Academy of Pediatrics' Policy on Circumcision? PEDIATRICS (May 2007); 119:1006-7. [Full text] [PDF]
There have been 3 recent studies in Africa, involving >10000 men, that have demonstrated a marked protective effect of male circumcision with respect to the acquisition of HIV infection. The protective effect was 60% in each of the 3 trials. Reviews of the literature have concluded that there is substantial evidence to support the conclusion that circumcision significantly reduces the rate of HIV infection, and one review concluded that "male circumcision is the most compelling evidence-based preventive strategy to emerge since the results of mother-to-child transmission clinical trials." Circumcision also protects against certain other sexually transmitted diseases (STDs). Authors of the first systematic review and meta-analysis of the association of male circumcision with ulcerative STDs (syphilis, cancroid, and genital herpes) concluded that circumcised men are at lower risk of acquiring cancroid and syphilis then uncircumcised men. There is also compelling evidence that male circumcision protects against human papillomavirus infection and, hence, cervical and penile cancer. I firmly believe that there is now sufficient, new information to prompt a revised AAP policy statement regarding neonatal circumcision, considering the very significant beneficial effects and the very minor risks associated with the procedure.
Comments. This commentary by Dr. Dickman is the strongest
endorsement I have seen for the benefits of circumcision. He suggests that we
now have sufficient evidence for the AAP to recommend routine neonatal
circumcision. I’m inclined to agree, but only if the procedure is done with
adequate local anesthesia for pain control. For more on the circumcision
debate, see
3-023,
3-025, and
7-041. ABK.
Date: 01 Jun 2007
Time: 08:00:58
I think you meant Dr Dickerman, not Dr. Dickman. I can see your thinking though! A wonderful slip which you should not remove or change.
UserName: Dr. Peter Reynolds
Institution: Neonatal Consultant, St. Peter's Hospital, UK
telephone:
email:
peter.reynolds@asph.nhs.uk
Date: 08 Jun 2007
Time:
22:20:58
My apologies to Dr. Dickerman. No pun was intended.
Andrew B.
Kairalla MD
Editor
Date: 02 Jun 2007
Time: 05:38:50
In our country we do circumcision to all infants , usually at birth and may be delayed to the late infancy period as part of the Muslim religion. Penile cancer and viral infection are rare in our community. Circumcision can prevent these disorders. A review of AAP recommendations is indicated.
UserName: FAWZYA AREF
Institution: maternity and children hospital - Jeddah KSA
telephone:
email:
fwzarif@yahoo.com
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