Editing CUA: Circumcision (2018) (section)

== Circumcision and risk of HPV ==

* '''High- risk oncogenic HPV subtypes, like 16 and 18, are implicated in''' cervical, penile, vulvar, vaginal, anal, and some oropharyngeal '''cancers, while low-risk non-oncogenic subtypes, like 6 and 11, cause genital warts'''
* '''HPV incidence or acquisition in men: No convincing evidence to suggest that MC decreases HPV acquisition or incident infections''' in HIV positive or -negative men (Level 1b‒2b).
* '''HPV prevalence in men''': Current evidence suggests a '''modest decrease''' in HPV prevalence in the glans and coronal sulcus up to 2 years following MC.
** The protective effect is partial, does not cover all high- risk types and is weaker further away from the glans and coronal sulcus.
** It is not clear whether this effect will persist into adulthood following neonatal circumcision.
* '''HPV clearance in men: No evidence''' (except a single RCT on HIV-negative men) '''that MC increases HPV clearance''' (Level 1b‒2b). If it did increase clearance, this may also inflate the impact of the prevalence benefits mentioned.
* '''HPV in female partners: MC lowers prevalence and incidence in partners of HIV-negative men and improves clearance rates''' (Level 1b‒2b).
* '''As a public health intervention, it is likely that the effect of HPV vaccination and behavioural modification will be more effective than performing universal neonatal circumcisions on all males'''