Association Between High-Risk Human Papillomavirus Prevalence and Circumcision Status Among Sexually Experienced Adult Men, 2013 to 2016, United States.

BACKGROUND

Randomized control trials in sub-Saharan countries found that male circumcision may prevent high-risk human papillomavirus (HR-HPV) acquisition. Using 2013-2016 National Health and Nutrition Examination Survey data, we explored the association between circumcision and HR-HPV among sexually experienced 18- to 59-year-old men.

METHODS

Self-collected penile specimens were tested for HPV DNA. We estimated weighted HR-HPV prevalence (positivity to ≥1 HR type: HPV-16/18/31/33/35/39/45/51/52/56/58/59/66/68) by circumcision status. The association between circumcision and HR-HPV was assessed using multivariable logistic regression models. Effect modification by circumcision on the association between number of lifetime sex partners and HR-HPV was explored.

RESULTS

Overall, 77.7% of men reported being circumcised, with large variation by race/ethnicity and country of birth. High-risk HPV prevalence was significantly higher among circumcised (25.7%) than uncircumcised (20.4%) men; this was attenuated after adjustment for lifetime and new past-year sex partners (adjusted prevalence ratio, 1.10; 95% confidence interval, 0.92-1.32). There was evidence that circumcision modified the association between lifetime partners and HR-HPV, but HR-HPV prevalence increased with increasing number of partners in circumcised and uncircumcised men.

CONCLUSIONS

Our observed lack of statistical association between circumcision and HR-HPV may differ from randomized trial results because of the differences between circumcised and uncircumcised men or differences in anatomic site sampled or timing of circumcision.