20th International AIDS Conference - Melbourne, Australia


MOPDC0103 - Poster Discussion Abstract

Male circumcision and the incidence of syphilis acquisition among male and female partners of HIV-1 serodiscordant heterosexual African couples: a prospective study

Presented by Jillian Pintye (United States).

J. Pintye1, J. Baeten1, L. Manhart1, C. Celum1, A. Ronald2,3, N. Mugo1,4, A. Mujugira1, C. Cohen4,5, E. Were6, E. Bukusi4,5, J. Kiarie1,7, R. Heffron1

1University of Washington, Department of Global Health, Seattle, United States, 2University of Manitoba, Winnipeg, Canada, 3Makerere University, Kampala, Uganda, 4Kenya Medical Research Institute, Nairobi, Kenya, 5University of California-San Francisco, San Francisco, United States, 6Moi University, Eldoret, Kenya, 7University of Nairobi, Nairobi, Kenya

Background: While male circumcision (MC) reduces HIV-1 infection and other sexually-transmitted infections, it is uncertain whether it reduces the risk of syphilis.
Methods: Data from a clinical trial of HIV-1 pre-exposure prophylaxis among African HIV-1 serodiscordant heterosexual couples (the Partners PrEP Study) were analyzed to assess the relationship between MC and the risk of incident syphilis. HIV-1 infected and uninfected men and women were assessed separately. Incident syphilis was defined as a Rapid Plasma Reagin (RPR) titer change of >4-fold with a positive Treponema pallidum-specific confirmatory result during annual visits or when clinically indicated. MC status was determined by physical examination and analyzed as a time-varying exposure. Andersen-Gill survival methods allowed for multiple events and all models were adjusted for sexual behavior, age, and HIV-1 viral load of the HIV-infected partner.
Results: 2946 HIV-1 serodiscordant couples in which the female was HIV-infected and 1751 HIV-1 serodiscordant couples in which the male was HIV-infected were followed for a median of 2.75 years. At enrollment, 1575 (53.5%) HIV-uninfected males and 560 (32.4%) HIV-infected males were circumcised, and 58 (10.2%) HIV-infected and 117 (8.5%) HIV-uninfected men were circumcised during study follow up. Baseline seroprevalent syphilis was present in 11 (1.9%) circumcised and 87 (7.9%) uncircumcised HIV-infected men and 33 (2.1%) circumcised and 65 (4.8%) uncircumcised HIV-uninfected men. During follow-up, syphilis incidence rates were 1.10 per 100 person-years for both HIV-infected and uninfected males, and 0.77 and 1.11 per 100 person-years for HIV-infected and uninfected females. When the male was HIV-infected, MC was associated with a 63% reduction in incident syphilis in the male (adjusted hazard ratio (AHR) 0.37, 95% CI 0.17-0.80) and a 75% reduction in incident syphilis in the female (AHR 0.25, 95% CI 0.08-0.77). When the male was HIV-uninfected, MC was associated with a 35% reduction in incident syphilis in the male (AHR 0.65, 95% CI 0.37-1.13) and a 48% reduction in incident syphilis in the female (AHR 0.52, 95% CI 0.28-0.97).
Conclusions: MC was associated with decreased risk of acquiring syphilis for men and women. If confirmed, these results suggest that MC could significantly reduce syphilis and sequelae, leading to public health benefits.

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