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Male circumcision and anatomic sites of penile high‐risk human papillomavirus in Rakai, Uganda

Male circumcision (MC) reduces penile high‐risk human papillomavirus (HR‐HPV) on the coronal sulcus and urethra. HR‐HPV varies by anatomic site, and it is unknown whether MC decreases HR‐HPV on the penile shaft. We assessed the efficacy of MC to reduce HR‐HPV on the penile shaft and compared it to known efficacy of MC to reduce HR‐HPV on the coronal sulcus. HIV‐negative men randomized to receive immediate circumcision (intervention) or circumcision delayed for 24 months (control) were evaluated for HR‐HPV at 12 months postenrollment using the Roche HPV Linear Array assay. Among swabs with detectable β‐globin or HPV, year 1 HR‐HPV prevalence on the coronal sulcus was 21.5% in the intervention arm and 36.3% in the control arm men [adjusted prevalence risk ratios (PRRs) = 0.57, 95% CI 0.39–0.84, p = 0.005]. On the shaft, year 1 HR‐HPV prevalence was 15.5% in the intervention and 23.8% in the control arm (adjusted PRR = 0.66, 95% CI 0.39–1.12, p = 0.12). Efficacy of MC to reduce HR‐HPV on the shaft was similar to efficacy on the coronal sulcus (p = 0.52). In a sensitivity analysis in which swabs without detectable β‐globin or HPV were included as HPV negative, prevalence of HR‐HPV on the shaft was lower in the intervention arm (7.8%) than control arm (13.6%; PRR 0.57, 95% CI 0.33–0.99, p < 0.05). HR‐HPV was more frequently detected on the coronal sulcus than penile shaft among uncircumcised men (36.3% vs. 23.8%, respectively, p = 0.02) and circumcised men (21.5% vs. 15.5%, respectively, p = 0.24). MC reduced HR‐HPV prevalence on both the coronal sulcus and shaft.