Foreskin and HIV
What is it about the foreskin that might increase risk of HIV transmission?
The interior side of the foreskin has a mucosal surface which is more susceptible to trauma than the tougher skin of the penile shaft or the glans. Moreover, the foreskin contains high levels of HIV target cells (such as Langerhan's cells). Indeed in a recent in vitro study of 14 foreskins, investigators from Chicago found that foreskin mucosal tissue had a 7-fold greater susceptibility to HIV-1 than cells in cervical tissue under the same conditions. Lastly, the presence of a foreskin appears to increase risk of ulcerative STDs such as chancroid and herpes, which are strong co-factors for HIV infection.
Thus there appears to be good biologic plausibility to the epidemiologic finding that male circumcision reduces risk of HIV infection.
References:
- Estrada CR et al. Biologic mechanisms of HIV infection of human foreskin: implications for transmission. Presentation at the American Urological Association, May 2002.
- Szabo R, Short R. How does male circumcision protect against HIV infection? BMJ 2000; 320:1592-1594.
- Moses S, Bailey RC, Ronald AR. Male circumcision: Assessment of health benefits and risks. Sex Transm Infect 1998;74:368-73.
The "Pearls" offer answers to commonly asked questions about family planning. These "Pearls" are prepared by Dr. James D. Shelton, Senior Medical Scientist, Office of Population, United States Agency for International Development (USAID)
