Circumcision

hpv-kling2ALAN KLING, M.D

Dr. Alan Kling is recognized as one of the foremost specialists in the field of HPV infections. Throughout his years as an HPV specialist, Dr. Kling has contributed to research and lectured at various medical schools, including Columbia, Cornell, Mount Sinai, NYU, and Yale as well as having been a part of a number of national panels on HPV and HPV prevention. His extensive research has allowed him to keep up with the latest HPV treatment protocols and to educate others in the field as well. While HPV is an important field of dermatological study for many physicians, Dr. Kling has clearly separated himself from the pack, making him the top HPV treatment specialist in NYC today.

Dr. Kling's private practice offices are located at his Park Avenue practice on the Upper East Side and in Park Slope, Brooklyn.

Q: What is the role of circumcision in the prevention of HPV?
A: The prevalence of both high risk and low risk HPV strains is significantly lower in circumcised men when compared to uncircumcised men. Circumcised men do not develop genital warts or condyloma as frequently as uncircumcised men.

The partners of circumcised men have a lower chance of contracting an HPV infection than the partners of uncircumcised men. Genital warts recur more frequently in uncircumcised men compared to circumcised men. Both high risk and low risk HPV types occur 20% – 70% less frequently in circumcised men compared to uncircumcised men.

Q: How does the circumcision status of the man affect the woman’s chances of getting cancer of the cervix?
A: Women will have a higher chance of contracting high risk HPV strains and cancer of the cervix after having sexual contact with a man who is uncircumcised. Uncircumcised men are more likely to harbor high risk strains of HPV than men who are circumcised.

Q: Why does the uncircumcised man have a greater risk of having an HPV infection?
A: The foreskin in an uncircumcised man provides a large surface area that is exposed to potential infection. The foreskin is also easily traumatized, resulting in multiple small breaks and micro-cuts through which the HPV virus can infect the skin.

Circumcised men have a lower chance of being carriers for HPV compared to uncircumcised men. Women who are exposed to men who are carriers of high risk HPV viruses are less likely to acquire an infection if their male partner is circumcised.

Q: Are HPV infections in uncircumcised men more difficult to treat?
A: HPV infections in uncircumcised men are more difficult to treat, have higher recurrence rates and are more likely to infect a partner than are infections in circumcised men. The increasing use of the HPV vaccine should decrease the incidence of infection in both circumcised and uncircumcised men.

Q: How will the increasing prevalence of men who are uncircumcised in the Untied States affect the incidence of HPV infections?
A: The number of uncircumcised men in the United States is increasing as the years go by. The trend in hospitals throughout the United States after World War 2 was to circumcise males shortly after birth because it would result in better hygiene and a lower incidence of a number of different genitourinary infections.

This guideline has not been adhered to adamantly in recent years. In addition, over the last several decades there has been increase immigration to the United States from Asian and Hispanic countries. In such regions, circumcision is not part of the culture and is not routinely practiced. These groups tend to carry on the tradition of not getting their sons circumcised. The Department of Health had historically issued health care guidelines encouraging parents to circumcise their sons but has more recently taken a more neutral position.

The increased prevalence of uncircumcised men in the United States would be expected to be associated with an increased incidence of HPV in the population. The use of the HPV vaccine to decrease the incidence of HPV would be expected to be associated with a decreased incidence of HPV in the population.

The end result of how these competing factors will balance out remains to be seen.

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