Does sex in the early period after circumcision increase HIV-seroconversion risk?

Does sex in the early period after circumcision increase HIV-seroconversion risk? Pooled analysis of adult male circumcision clinical trials. AIDS, 29 June 2009, epub ahead of print.

Mehta SD, et al. (Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA)

OBJECTIVE: To evaluate whether sexual intercourse soon after adult male circumcision affected HIV risk.

DESIGN: Combined analysis of data from African trials of men who were randomized to and underwent circumcision.

METHODS: We examined two associations: early sex (intercourse <42 days after circumcision) and HIV acquisition at 3 months for the Orange Farm and Kisumu trials and at 6 months for the Rakai and Kisumu trials and incomplete wound healing at 1 month and seroconversion at 3 and 6 months for the Kisumu trial and at 6 months for the Rakai trial.

RESULTS: Early sex was reported by 3.9% of participants in Kisumu, 5.4% in Rakai, and 22.5% in Orange Farm. HIV seroprevalence was 0.0% at 3 months and 1.9% at 6 months among 18-24-year-olds reporting early sex and 0.2% at 3 months and 0.6% at 6 months among those who did not report early sex. In pooled analyses, men reporting early sex did not have higher HIV infection risk at 3 or 6 months. In Kisumu, 16 (1.3%) men had incomplete wound healing at the 30-day visit. One (6.3%) of these seroconverted at 3 months compared with 2 (0.2%) of 1246 men with complete wound healing (P = 0.075). No association was observed between incomplete wound healing and seroconversion for Rakai participants.

CONCLUSION: Most men delayed intercourse after circumcision. Early sex after circumcision was not associated with HIV risk, although the study power was limited. Nevertheless, men should delay intercourse to limit the potential for increased HIV risk until complete wound healing.

PMID: 19571722 [PubMed - as supplied by publisher]

[IRMA reminds readers that circumcised men in these trials were 50 to 60 percent less likely to get HIV from having (what is presumed to be mostly) vaginal sex. This does not mean that circumcised men cannot get or transmit HIV. It only means that they are about half as likely as uncircumcised men to get HIV from having vaginal sex with a woman who has HIV.

Trial data have not shown that circumcision makes a man less likely to transmit HIV to his partner through vaginal sex. In fact, one trial showed the opposite. This trial enrolled Ugandan married couples in which the husbands were HIV-positive and wives were HIV-negative. The wives of the men who got circumcised in this trial appeared to be at greater risk of getting HIV than the women married to uncircumcised men. The increased risk may have occurred when couples started having sex again before the skin on the man’s penis had fully healed (become keratinised) – a process that takes about six weeks.

Trial data also do not show whether circumcision lowers the risk of transmission for either men or women during unprotected anal sex.]

For more on male circumcision.

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