Trauma, and Genital and Urethral Reconstruction.
Trauma, and Genital and Urethral Reconstruction.
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创伤、生殖器和尿道重建。
DOI：
10.1097/ju.0000000000002365
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发表时间：
2021
影响因子：
6.6
通讯作者：
S. Elliott
中科院分区：
文献类型：
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作者：
S. Elliott
编辑评论：在此，Smith等人报告了先前报道的在肯尼亚进行的2700多名男性包皮环切随机对照试验的二次分析结果。在最初的出版物中，他们（以及大约在同一时期发表的其他出版物）表明，包皮环切术可以将女性向男性的艾滋病毒传播减少50%至60%。在此，他们证明了包皮环切术在人类乳头状瘤病毒（HPV）事件感染、HPV清除和HPV再感染方面的益处，在同一包皮环切试验组中，有2000多名男性也进行了HPV检测。需要明确的是，所有这些男性在基线时都是HIV阴性但大约一半是HPV阳性，35%是高危HPV血清型。结果是积极的、强有力的、持久的，并且在多个结果测量中是一致的。这些发现很重要，因为HPV（特别是16/18亚型）是阴茎癌、宫颈癌和肛门癌的危险因素。此前也有研究表明，男性包皮环切术也能降低HPV在男性与女性之间的传播率。在24个月时，包皮环切术的男性HPV感染发生率降低了40%，并且支持概念的有效性，在龟头而不是阴茎标本中看到了益处。这40%在所有HPV血清学亚型中相当一致。偶发性感染被定义为在基线时血清型阴性的男性中检测呈阳性。割过包皮的男性HPV再感染率也降低了35%；这被定义为在基线时呈阳性，随后进行阴性测试，然后再次转为阳性。割过包皮的男性也更有可能清除感染，无论是基线时存在的普遍感染（清除率比1.87）还是基线时不存在的偶发感染（清除率比1.68）。同样，对于低风险和高风险的血清学亚型，这种益处都很强。
Editorial Comment: Herein, Smith et al report the results of a secondary analysis of a previously reported circumcision randomized controlled trial performed in Kenya on more than 2,700 men. In the original publication they (and others published around the same time) showed that circumcision reduces female-to-male HIV transmission by 50% e60%. 1e3 Herein, they demonstrate the benefit of circumcision in human papilloma virus (HPV) incident infection, HPV clearance and HPV reinfection among a subset of over 2,000 men in this same circumcision trial group who also had HPV testing. To be clear, all of these men were negative for HIV at baseline but about half were HPV positive, 35% with high-risk HPV serotypes. The results are positive, strong, durable over time and consistent across multiple outcomes measures. These findings are important because HPV (particularly subtype 16/18) is a risk factor for penile, cervical and anal cancer). Others have previously shown that male circumcision also reduces the rate of male-to-female HPV transmission. 4At 24 months, circumcised men had a 40% lower incidence of HPV infection and, supporting the concept validity, the benefit was seen in the glans, but not shaft specimens. This 40% was fairly consistent across all HPV serological subtypes. Incident infection was defined as a positive test among men who were negative for that serotype at baseline. Circumcised men also had a 35% lower HPV reinfection rate; this was defined as positive at baseline, followed by a negative test and then turning positive again. Circumcised men were also more likely to clear an infection, whether it was a prevalent infection present at baseline (HR of clearance 1.87) or an incident infection not present at baseline (HR of clearance 1.68). Again, this benefit was strong for both low-risk and high-risk serological subtypes.