NEJM: The Bris is Healthy -- Circumcision Prevents Diseases -- Nice to Know

We Jews circumcise our male children on the eighth day because we were commanded to do so as a religious sign of our covenant with God.

The fact that after all these years we discover that there are health benefits associated with male circumcision -- as the song in Fiddler on the Roof says, "It doesn't change a thing, but even so... it's nice to know."

The NEJM abstract is here. The WSJ story summarizes:

Circumcision Decreases Risk of Contracting STDs, Study Says
By PHILIP SHISHKIN

Circumcision significantly reduces the risk of contracting herpes and human papillomavirus, says a new study that adds to the growing scientific evidence that the procedure helps stem the spread of some sexually transmitted diseases.

Circumcised heterosexual men are 35% less likely to contract human papillomavirus (HPV) and 25% less likely to catch herpes than their uncircumcised counterparts, according to the study, published in this week's New England Journal of Medicine.

The study, led by scientists from Johns Hopkins University and Makerere University in Uganda, relied on data from the same randomized control trials in Africa that already showed that circumcision cuts in half the risk of contracting human immunodeficiency virus (HIV), which can cause AIDS.

The researchers hope the latest findings on HPV and herpes will help turn circumcision into a more widespread medical procedure. "The scientific evidence for the public-health benefits of male circumcision is overwhelming now," says Aaron Tobian, a pathologist at the Johns Hopkins Hospital and one of the study's authors.

In the study, researchers randomly assigned 1,684 men in Africa to undergo circumcision and tracked their health against a control group of 1,709 uncircumcised men over the course of two years ending in 2007.

HPV and herpes are among the most common sexually transmitted diseases in the U.S., far more common than AIDS. HPV can cause genital warts and cervical cancer. There are no cures for herpes and HPV.

Just over half of male newborns in the U.S. get circumcised, according to research published earlier this year in the American Journal of Public Health. The percentage has declined over the past decade, in part because the American Academy of Pediatrics said in 1999 that the evidence is "not sufficient to recommend routine neonatal circumcision."

Opponents of circumcision say the procedure isn't medically essential and causes unnecessary distress to the baby. They add that proper hygiene and safe sex can prevent disease.

The academy's guidance, issued before the landmark African trials, remains in effect. Partly as a result, Medicaid plans in 16 states don't pay for circumcision, according to the American Journal of Public Health. Circumcision rates in states with Medicaid coverage for the procedure are nearly 70%, while in the states without such coverage just 31% of male newborns get circumcised, the Journal said. Medicaid is the state-federal insurance program for the needy.

Lack of Medicaid coverage for circumcision -- combined with data showing higher incidence of sexually transmitted diseases in uncircumcised men -- "may translate into future health disparities for children born to poor families," says the study in the American Journal of Public Health.

In light of the new data coming out of the African trials, the American Academy of Pediatrics says it is reviewing its circumcision guidelines, a process that should be finished by the end of the year. "There's no argument that the trials that have been done are really compelling," says Susan Blank, chairwoman of the academy's task force on neonatal circumcision. "That is just one piece in the discussion of circumcision." The academy's panel also includes experts on urinary-tract infections, ethics and health-care finance among others, she says.