18 May 2006
Back To The Future For Syphilis Research
by George Atkinson

In the mid 19th century, a doctor named Jonathan Hutchinson published the first report suggesting that male circumcision may be protective against syphilis. He observed that among men seeking help with venereal disease, circumcised (Jewish) men were less likely to suffer from syphilis than uncircumcised men.

Several decades later, another doctor - Ephraim Epstein, pointed out that the association between syphilis and male circumcision could actually be due to spiritual beliefs and practices, rather than any physiological factor. "In common with others, once I believed that circumcision affords a protection against venereal diseases, but my practice in Vienna, and in this country since 1862, persuaded me fully to the contrary. The apparent immunity which Jews of Russia and European Turkey seem to enjoy from venereal diseases arises from their greater chastity," noted Epstein at the time.

Since then, the possible pros and cons of circumcision have been debated at great length with no clear-cut consensus achieved. In recent years, the waters have become muddied even further with compelling findings indicating that circumcision may in some way prevent the transmission of HIV. These findings were bolstered somewhat by another study that found that the foreskin's inner lining (mucosa) has cells that bind to the HIV virus more easily and can harbor nine times more virus in them than the outer layer of the foreskin.

Now - in something of a re-run of Hutchinson's work 150 years ago - a new study from the London School of Hygiene and Tropical Medicine has found that circumcision may indeed offer some protection from syphilis. The study was actually a meta-study, a review of previous epidemiological studies that focused on herpes simplex, syphilis and ulcerative sexually transmitted diseases. The researchers wanted to ascertain whether circumcised men's reduced risk of HIV infection may be partly because of a protective effect of circumcision on other sexually transmitted infections - especially those causing genital ulcers.

The review found that circumcised men were at lower risk of chancroid in six of the seven previous studies. They were also at a "substantially reduced risk" of syphilis, but there was no reduction in risk for herpes transmission among circumcised men. The researchers said the findings indicated that male circumcision may be effective in reducing HIV in high risk populations, and may also provide additional benefits by protecting against other sexually transmitted infections.

Based on material from the journal Sexually Transmitted Infections

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