Officials at the Centers for Disease Control and Prevention are asking for feedback on the agency’s new draft recommendations for counseling patients and parents considering male circumcision.
The recommendations, which the CDC released on Dec. 2, cover newborns, children, adolescents, and adults.
The draft draws on evidence from randomized, controlled trials showing that circumsized adult men have a significantly lower risk of acquiring HIV and other sexually transmitted infections through vaginal sexual intercourse. The CDC also cited the prevention of urinary tract infections and penile cancer as benefits of circumcision.
The rationale for the CDC draft recommendations closely mirrors that of guidelines issued in 2012 by the American Academy of Pediatrics (AAP) and endorsed by the American College of Obstetricians and Gynecologists (Pediatrics 2012;130:585-6). The 2012 document broke from earlier guidelines that did not recommend routine circumcision of male newborns. The AAP determined that there was sufficient evidence that the health benefits outweighed the risks, to the point that any family wanting the procedure should have access to it.
The CDC’s draft recommendations urge clinicians to review the health benefits and risks of elective male circumcision, whether in newborns, adolescents, or adults, while also taking into account other factors, such as “religion, societal norms and social customs, hygiene, aesthetic preference, and ethical considerations.”
The CDC draft includes specific recommendations for counseling patients and parents of each age group.
When advising adolescent and adult men, CDC recommends:
• Counseling all sexually active patients on HIV and STI risk-reduction strategies, such as condoms, regardless of circumcision status.
• Assessing risk behaviors, HIV status, and the gender of sexual partners before discussing the risks and benefits of circumcision.
• Informing uncircumcised men and boys engaged in vaginal sexual intercourse about the partial protection against HIV afforded by male circumcision.
• Advising patients that male circumcision has not been proven to reduce HIV/STI acquisition through oral or anal sex.
When advising parents about circumcision of newborns, children, and adolescent minors, CDC recommends:
• Counseling parents before the baby is born, if possible.
• Advising that circumcised newborn males are less likely to experience urinary tract infections, balanitis, and balanoposthitis.
• Advising that neonatal circumcision is safer and less expensive than is circumcision later in childhood, with complications occurring less frequently in newborns and more frequently among children aged 1-10 years.
• Discussing the likely benefits in terms of HIV and STI protection after sexual debut.
• Advising that circumcised males appear less likely to develop penile cancer and possibly prostate cancer.
The CDC will publish the new recommendations in the Federal Register sometime after the public comment period closes and the peer review process is complete. The deadline for public comments is Jan. 16.