Association between male circumcision and human papillomavirus infection in males and females: a systematic review, meta-analysis, and meta-regression

Previous studies have suggested a protective effect of male circumcision on human papillomavirus (HPV) infections in males, and that this protection may be conferred to their female sexual partners. To synthesize the available evidence on the association between male circumcision and HPV infections in males and females. We searched MEDLINE, Embase, Scopus, Cochrane, LILACS, and ProQuest Dissertations & Theses Global for records published up to 22 June 2022. We considered observational and experimental studies that assessed male circumcision status and HPV prevalence, incidence, or clearance in males or females for inclusion. Males and their female sexual partners who were tested for genital HPV infection. Male circumcision compared with no circumcision. The Newcastle-Ottawa scale was used for observational studies, and the Cochrane risk-of-bias tool was used for randomized trials. We estimated summary measures of effect and 95% CIs for the prevalence, incidence, and clearance of HPV infections in males and females using random-effects meta-analysis. We assessed the effect modification of circumcision on HPV prevalence by the penile site in males using random-effects meta-regression. Across 32 studies, male circumcision was associated with decreased odds of prevalent HPV infections (odds ratio, 0.45; 95% CI, 0.34–0.61), a reduced incidence rate of HPV infections (incidence rate ratio, 0.69; 95% CI, 0.57–0.83), and an increased risk of clearing HPV infections (risk ratio, 1.44; 95% CI, 1.28–1.61) at the glans penis among male subjects. Circumcision conferred greater protection against infection at the glans than the shaft (odds ratio, 0.68; 95% CI, 0.48–0.98). Females with circumcised partners were protected from all outcomes. Male circumcision may protect against various HPV infection outcomes, suggesting its prophylactic potential. Understanding the site-specific effects of circumcision on HPV infection prevalence has important implications for studies of HPV transmission.