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Can a circumcised man get a uti

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Highest risk is in infancy, where UTI is times higher in uncircumcised males. The highest prevalence and greatest severity of UTIs in boys is prior to 6 months of age [Wiswell, a; Schoen et al. The younger the infant, the more likely and severe will be the UTI and the greater the risk of sepsis and death [Schoen, c]. Moreover, a New Zealand study found no relationship between circumcision status and breastfeeding outcomes, nor health and cognitive ability outcomes [Fergusson et al. Thus circumcision does not disrupt breastfeeding. Research showing an association of UTI with lack of circumcision is extensive and the link is now unequivocal.

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The Relationship between Neonatal Circumcision, Urinary Tract Infection, and Health

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Worldwide, male circumcision is done for religious or cultural reasons, and to a lesser degree for medical indications. Newborn male circumcision is associated with fewer genitourinary infections in younger males.

In the current decade, a substantial body of research suggests that male circumcision is effective as a prophylactic measure against HIV and other sexually transmitted infections. The compelling HIV reductions in 3 African randomized control trials in circumcised men have prompted use of male circumcision as a key part of HIV prevention in developing nations.

More recently, the use of male circumcision as a public health measure in developed nations is a topic of international discussion. Contemporary discussion of male circumcision relates to its utility as a public health measure — specifically in the prevention of genitourinary and sexually transmitted infections.

Most professional organizations in developed nations do not recommended routine use of newborn male circumcision but recognize its use in disease prevention. This chapter will discuss the impact of male circumcision in the context of the health promotion and health prevention specific to genitourinary and sexually transmitted infections. Male circumcision involves cutting and removing all or part of the foreskin, or prepuce, from the glans penis.

To understand the rationale for the use of male circumcision MC in prevention of infections, it is important to understand the function and physiology of the foreskin. At birth, the glans penis and inner foreskin share a common, fused mucosal epithelium called the balano-preputial lamina BPL. By age 10 most boys have a retractable foreskin, and by age 17, natural separation of the foreskin from the glans penis is complete [ 15 ] Figure 1.

There are divergent viewpoints on the purpose and function of the foreskin. MC opponents view the keratinized squamous epithelium that covers the penile shaft and the foreskin in the uncircumcised penis as having protective functions. Beyond being epithelial debris, smegma is a natural emollient that protects and lubricates the glans. It is contended that neonatal male circumcision not only removes tissue containing fine-touch receptors but interferes with the natural separation process.

This may lead to subsequent sensory imbalance and risk of injury and tears that make the circumcised penis less hygienic and more prone to infection [ 17 ].

The alternate view is that the biochemical and structural properties of the intact foreskin result in increased acquisition of HIV and other STIs. Lymphoid areas of mucosal surfaces are primary sites for HIV infection. Foreskin tissue has been identified as both having abundant HIV target cells and susceptibility to trauma because of its thinly keratinized surface [ 18 ].

Structurally, the folding of the foreskin on the non-erect uncircumcised penis creates a sub-preputial space which is eliminated on the erect penis. By removing the foreskin surgically, this space is eliminated thereby removing the reservoir for HIV, human papilloma virus HPV , and other pathogens [ 19 , 20 , 21 ].

In theory, removal of the foreskin HIV reduces target cells, eliminates the sticky medium for viruses, exposes the more keratinized penile shaft and eliminates the sub-preputial space which collectively diminishes pathogen exposure. The strongest risk factors are renal tract abnormalities, which are relatively rare [ 24 ]. Common risk factors are female gender, young age, and uncircumcised state in boys [ 22 , 25 , 26 ].

As the uncircumcised foreskin may support the growth of pathogenic bacteria at the meatus [ 28 ], this decline in UTI prevalence in boys likely occurred because of the physiologic retraction of the prepuce over time [ 16 ]. The associations of MC and UTI in older studies were limited due to having samples with disproportionately larger groups of circumcised boys and generally, because of being single studies of observational, non-experimental design.

More robust evidence of the disease prevention potential of MC with respect to UTI has come about from more recent multi-study reviews [ 26 , 29 ]. One of these, a meta-analysis of 22 studies 21 observational and one randomized controlled trial of 70 participants examined lack of circumcision as a risk factor for UTI and reported a lifetime relative risk of UTI as 3. Stratified for age, the risk of UTI was 9. These results are consistent with the known decline of UTIs in males as they mature, but also suggest that the effect of MC in UTI prevention is most evident in infants and younger boys.

Recurrent UTIs are the principal cause of permanent kidney tissue scarring in children, so interventions that reduce frequency of UTIs are needed to prevent short and long-term morbidity. This suggests that use of MC particularly in higher risk groups of boys is an intervention to reduce UTI, subsequent renal scarring and loss of renal reserve.

Prenatal identification of high-grade hydronephrosis has been associated with VUR and 3-fold increase in UTIs, so such findings may warrant consideration of early infant male circumcision [ 33 ].

Genetics has increasing importance in identifying those at risk for recurrent UTI. Genes have been identified that cause inefficient bacterial clearance and greater susceptibility to UTIs [ 34 ]. Syndromes in which there are genital tract anomalies, most prominently, vesicoureteral reflux, may increase the risk for recurrent UTI [ 24 , 32 , 33 ]. Worldwide, more than 1 million sexually transmitted infections STIs are acquired daily [ 35 , 36 ].

Organisms causing STIs are bacterial, protozoal, and viral. Those with bacterial chlamydia, gonorrhea, syphilis or protozoal trichomonas causes are treatable while those caused by viruses herpes simplex, human papilloma, HIV are not [ 36 , 37 ].

Each year, million new infections are caused by chlamydia, gonorrhea, syphilis and trichomonas and more than million persons experience genital infections from herpes simplex virus HSV [ 36 , 38 ] Figure 2.

Longer term, STIs can have serious reproductive health consequences beyond the immediate impact of the infection such as infertility, mother-to-child transmission and genitourinary cancers. Moreover, people with sexually transmitted infections often experience stigma, stereotyping, vulnerability, shame and gender-based violence [ 35 ]. Estimated prevalence of chlamydia, gonorrhea, trichomoniasis and active syphilis in women aged 15—49 years by WHO region, — Source: WHO Report on global sexually transmitted infection surveillance, The health burden of HIV infections is greatest in developing countries where HIV is more prevalent, and treatment is least available.

Figure 3 shows geographic extremes ranging from 0. Of the Globally, there were almost 90, more new HIV infections among men than women in [ 40 ]. Therefore, reaching more men with HIV treatment but more proactively, with preventive measures such as circumcision, is critical to breaking cycles of HIV transmission and reducing HIV incidence among young women.

If fewer men acquire HIV because of male circumcision, this will benefit women by reducing exposure to HIV-infected men. The potential of male circumcision to protect from heterosexual HIV infection was first suggested in [ 41 ]. Subsequently, a rich body of research done in developing countries has emerged focusing on the relationship between male circumcision and heterosexual HIV acquisition in men.

Although the women in the studies did not experience individual protective benefit of HIV from partners with MC, the reduction of HIV in men with MC is important from a population reduction perspective. A study of heterosexual men in a Baltimore, Maryland United States reported that 2.

Among visits by patients with known HIV exposure, circumcision was significantly associated with lower HIV prevalence However, the higher rate of HIV transmission in couples who initiated intercourse soon after MC compared to those who waited until healing occurred, underscores the importance of delaying intercourse until the MC wound is healed.

Male circumcision does not appear to decrease HIV acquisition in their female partners on an individual level but decreasing new HIV infections overall will ultimately reduce the HIV burden in the population overall.

The case for MC as a preventive measure is less compelling in areas where HIV acquisition is largely due to men who have sex with men. In developed countries, where HIV prevalence overall is low, most HIV are cases are related to homosexual transmission e. Further, developed countries have access to antivirals for prevention as well as for treatment of HIV infection which keep prevalence of new infections and AIDs mortality low.

The overall pooled risk ratio RR for both homosexual and heterosexual men was 0. Although the study suggests that MC was effective in reducing HIV risk for both heterosexual and homosexual men, the effect was dramatically lower in homosexual men.

Male circumcision represents one of very few proven HIV prevention strategies particularly in high prevalence areas, such as sub-Saharan Africa where transmission is largely related to heterosexual contact.

It is less clear whether voluntary male medical circumcision programs, such as those employed in Africa would be as beneficial in developed nations. Theoretically, certain groups in the United States, e.

African-American and Hispanic men with higher risk of HIV infections could benefit but this impact would be much less profound [ 12 ].

Human papillomavirus HPV has been established as the leading cause of invasive cervical cancer in women and is associated with anogenital warts and cancers in men and women [ 55 ]. HPV strains are classified as either low-risk causes benign lesions or high-risk causes malignancies. Oncogenic high-risk strains e. HPV types 16 and 18 cause most of the HPV-related cancers and pre-cancers, while the low-risk strains cause genital warts or mild Pap test abnormalities.

Most sexually active persons will contract HPV infection at some time in their lives but in most cases, the infection will be asymptomatic and clear spontaneously. Risk factors associated with HPV infection include, increased exposure to the virus via multiple partners, decreased condom usage, history of other STIs, tobacco usage, and for women, having sex with an uncircumcised partner [ 56 ].

More than million women have human papillomavirus HPV infection [ 57 ]. Worldwide, cervical cancer is the fourth most frequent cancer in women and fourth leading cause of death in women. In developing countries, cervical cancer ranks second breast cancer is first in incidence and mortality. Absent of such health resources, MC in their partners provides a means of HPV prevention and exposure reduction for women.

Therefore, the procedure of MC itself removes a reservoir for viruses, such as HPV, thus reducing exposure over the long-term. As the precursor of cervical cancer, reducing high-risk HPV transmission is a critical part of disease prevention. In the cervical cancer and cervical dysplasia groups, there were no RCTs, but the quality of the studies was graded using the Newcastle-Ottawa scale for non-randomized studies. In the same review, four of the five cases reviewed also showed that MC was highly protective of cervical dysplasia and moderately protective of HPV infection.

In developed countries, access to HPV vaccination along with early identification and treatment of cervical dysplasia is a well-established part of preventive health care for women. In resource poor countries without such preventive care programs, the protective effect of MC on cervical dysplasia and cancer offers a critical means of preventing morbidity and mortality in women.

More attention has been on HPV infection in women because of its association with cervical cancer. In men, manifestations of HPV infection range from genital warts and mild dysplasia low-risk strains to rarely, anogenital cancers high-risk strains.

Two reviews and meta-analyses analyzed the effect of male circumcision on genital HPV infection in men. However, no associations were found in the acquisition of new HPV infections, genital HPV clearance, or genital warts [ 62 ]. Penile cancer is rare—globally with 0. High-risk HPV infection has a considerable role in penile cancer, but with less consistency than in cervical cancer. Therefore, male circumcision may provide a direct benefit for HIV-positive men by preventing penile HR-HPV infection and thus potentially averting penile cancer.

In addition, it is possible that circumcision of HIV-infected men may protect female partners from infection and potentially from cervical neoplasia. Male circumcision has a role in the acquisition of other sexually transmitted infections. Although MC has not been directly associated with decreases in HIV transmission to female partners [ 5 ] Table 1 it is still important to understand whether MC affects ulcerative sexually transmitted infections such as HSV type 2 [ 66 , 67 , 68 ] and syphilis [ 67 , 69 ] both of which are associated with an increased risk of HIV.

HSV-1 is mainly transmitted by oral contact to cause infection in or around the mouth oral herpes. HSV-2 is almost exclusively sexually transmitted, causing infection in the genital or anal area genital herpes [ 70 ].

HSV infection is highly stigmatized and negatively impacts relationships. However, more critical is its potential for perinatal transmission, resulting newborn morbidity and mortality [ 71 , 72 , 73 ] and its well-documented relationship with HIV. Perinatal transmission mostly occurs during delivery from mothers with herpes simplex virus HSV-1 or HSV-2 genital infection.

Therefore, understanding the relationship between MC and HSV transmission is important as circumcision may afford important benefit in terms of reductions in HSV infections, particularly in female partners in their childbearing years. HSV-2 is a leading cause of genital ulcer disease worldwide, but prevalence by global region differs [ 71 ].

Male Circumcision and Infection

The risk-benefit profile of neonatal circumcision is not clear. Most studies have focused on urinary tract infections but other health sequelae have not been evaluated. While evidence supports benefits of circumcision, a lack of randomized trials has been cited as a weakness.

Worldwide, male circumcision is done for religious or cultural reasons, and to a lesser degree for medical indications. Newborn male circumcision is associated with fewer genitourinary infections in younger males.

Before circumcision, the foreskin covers the tip of the penis glans. After circumcision, the tip of the penis is exposed. Circumcision is the surgical removal of the skin covering the tip of the penis. The procedure is fairly common for newborn boys in certain parts of the world, including the United States.

Male circumcision greatly increases risk of urinary tract problems

Learn about our expanded patient care options for your health care needs. A team of disease experts and health economists at Johns Hopkins warns that steadily declining rates of U. Senior study investigator, health epidemiologist and pathologist Aaron Tobian, M. Rates in Europe average only 10 percent, and in Denmark, only 1. Among their female sex partners, there would be 50 percent more cases each of bacterial vaginosis , and trichomoniasis 64, The number of new infections with the high-risk form of human papillomavirus, which is closely linked to cervical cancer in women, would increase by 18 percent 33, more infections. Tobian says state funding cuts in Medicaid, the government medical assistance program for the poor, have substantially reduced numbers of U. The problem in the United States is compounded, Tobian says, by the failure of the American Academy of Pediatrics to recognize the medical evidence in support of male circumcision. The Johns Hopkins team says it plans to share its study findings among state government officials across the United States to help raise awareness of its medical and cost-benefit analysis. In the study, researchers constructed a novel economic model to predict the cost implications of not circumcising a male newborn.

COVID-19 Update

She has my sympathies—urinary tract infections are painful and their association with sex is distressing. Unfortunately, few people seem to actually understand why they occur or how to prevent them. To start with since the instigation of this post focused on the status of the male member, let me say clearly—whether a male partner is circumcised or intact is not a factor in UTIs. How do the little buggers get from the butt to the urethra? We transport them there by ourselves or with the help of our sexual partners.

Among the few alleged benefits of circumcision that are of actual relevance to children, the most prominent is the claim that it protects against urinary tract infections in the first year of life.

Uncircumcised boys are at a higher risk for urinary tract infections compared with circumcised boys, a new study finds. The study involved close to boys ages 3 years or younger who went to the hospital with symptoms of a urinary tract infection. Results showed that about 25 percent of uncircumcised boys had urinary tract infection s, compared with 5 percent of circumcised boys.

Urinary Tract Infections

Brian Morris at the University of Sydney and Thomas Wiswell a neonatologist in Orlando concluded that, over the lifetime, the single risk factor of the foreskin confers a 1-in-4 chance of getting a UTI during the male lifetime. This represented the difference between lifetime UTI prevalence in uncircumcised males 1-in-3 and lifetime prevalence in circumcised males 1-in It was found that circumcision reduced the risk of an infant getting a UTI by fold.

Design and Setting. Main Outcome Measure. Escherichia coli was the most common urinary isolate 15 of 26 isolates , and the majority of E coli strains possessed urovirulence determinants, including mannoseresistant hemagglutination 10 of 14 isolates , F fimbriae 11 of 14 isolates , P fimbriae 6 of 14 isolates , hemolysin 10 of 14 isolates , and aerobactin 8 of 14 isolates. Coronavirus Resource Center. All Rights Reserved. Twitter Facebook Email.

Lack of Circumcision Increases the Risk of Urinary Tract Infection in Young Men

Circumcision, whereby the foreskin is removed from the penis, can cause the urethral opening to narrow, making it difficult to urinate. The condition is called meatal stenosis and the risk of developing it is times higher in circumcised than intact boys under the age of ten. Meatal stenosis can occur several years after circumcision, and may lead to infection if left untreated. The only solution is a minor operation under general anaesthesia. In , the Danish National Board of Health estimated that between 1, and 2, boys are ritually circumcised in Denmark each year. If one combines these estimates with the percentages mentioned by Frisch, somewhere between 50 and Danish boys and men will develop a narrowing of their urinary opening each year.

Circumcision - infections of the urinary tract (UTI) are regarded as being up to 44% of uncircumcised men, compared with 6% of circumcised men will get a UTI.

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Study: Uncircumcised Boys Have a Higher Risk of UTI

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Circumcision May Lower Urinary Infection Risk

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