Male Circumcision Reduces Penile HPV Incidence and Persistence: A Randomized Controlled Trial in Kenya

Cancer Epidemiol Biomarkers Prev. 2021 Jun;30(6):1139-1148. doi: 10.1158/1055-9965.EPI-20-1272. Epub 2021 May 10.


Background: Male circumcision reduces the risk of human immunodeficiency virus infection in men. We assessed the effect of male circumcision on the incidence and natural history of human papillomavirus (HPV) in a randomized clinical trial in Kisumu, Kenya.

Methods: Sexually active, 18- to 24-year-old men provided penile exfoliated cells for HPV DNA testing every 6 months for 2 years. HPV DNA was detected via GP5+/6+ PCR in glans/coronal sulcus and in shaft samples. HPV incidence and persistence were assessed by intent-to-treat analyses.

Results: A total of 2,193 men participated (1,096 randomized to circumcision; 1,097 controls). HPV prevalence was 50% at baseline for both groups and dropped to 23.7% at 24 months in the circumcision group, and 41.0% in control group. Incident infection of any HPV type over 24 months was lower among men in the circumcision group than in the control group [HR = 0.61; 95% confidence interval (CI), 0.52-0.72]. Clearance rate of any HPV infection over 24 months was higher in the circumcision group than in the control group (HR = 1.87; 95% CI, 1.49-2.34). Lower HPV point-prevalence, lower HPV incidence, and higher HPV clearance in the circumcision group were observed in glans but not in shaft samples.

Conclusion: Male circumcision reduced the risk of HPV acquisition and reinfection, and increased HPV clearance in the glans.

Impact: Providing voluntary, safe, and affordable male circumcision should help reduce HPV infections in men, and consequently, HPV-associated disease in their partners.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Alphapapillomavirus / genetics
  • Alphapapillomavirus / isolation & purification
  • Circumcision, Male / statistics & numerical data*
  • DNA, Viral / isolation & purification
  • Humans
  • Incidence
  • Intention to Treat Analysis
  • Kenya
  • Male
  • Papillomavirus Infections / diagnosis
  • Papillomavirus Infections / epidemiology*
  • Papillomavirus Infections / prevention & control
  • Papillomavirus Infections / virology
  • Penile Diseases / diagnosis
  • Penile Diseases / epidemiology*
  • Penile Diseases / prevention & control
  • Penile Diseases / virology
  • Penis / surgery
  • Penis / virology*
  • Persistent Infection / diagnosis
  • Persistent Infection / epidemiology*
  • Persistent Infection / prevention & control
  • Persistent Infection / virology
  • Treatment Outcome
  • Young Adult


  • DNA, Viral