Risks of not circumcising c c These data show that the risk to an uncircumcised male of developing a condition requiring medical attention during their lifetime is approximately 1 in 2. Values shown are mostly based on statistics for the United States unless RCT data were available from other countries. State-of-the-art reviews are shown where possible rather than individual studies. Information on sexually transmitted infections applies to those acquired in heterosexual males.

Urinary tract infection: age 0-1 y 9.9 (7.5-13) 1++ 1.3 d d The percentage of uncircumcised affected is the inverse of the number needed to treat value, which is the approximate number of males who need to be circumcised to prevent 1 case of each condition associated with lack of circumcision. Morris and Wiswell, 17 Morris B.J.

Wiswell T.E. Circumcision and lifetime risk of urinary tract infections: a systematic review and meta-analysis.

Urinary tract infection: age l-16 y 6.6 (3.3-13) 1++ 2.7 d d The percentage of uncircumcised affected is the inverse of the number needed to treat value, which is the approximate number of males who need to be circumcised to prevent 1 case of each condition associated with lack of circumcision. Morris and Wiswell, 17 Morris B.J.

Wiswell T.E. Circumcision and lifetime risk of urinary tract infections: a systematic review and meta-analysis.

Urinary tract infection: age >16 y 3.4 (0.92-50) 1+ 28 d d The percentage of uncircumcised affected is the inverse of the number needed to treat value, which is the approximate number of males who need to be circumcised to prevent 1 case of each condition associated with lack of circumcision. Morris and Wiswell, 17 Morris B.J.

Wiswell T.E. Circumcision and lifetime risk of urinary tract infections: a systematic review and meta-analysis.

Urinary tract infection: lifetime 3.6 (1.8-5.7) 1+ 32 d d The percentage of uncircumcised affected is the inverse of the number needed to treat value, which is the approximate number of males who need to be circumcised to prevent 1 case of each condition associated with lack of circumcision. Morris and Wiswell, 17 Morris B.J.

Wiswell T.E. Circumcision and lifetime risk of urinary tract infections: a systematic review and meta-analysis.

Pyelonephritis (infants) 10 2+ 0.6 d d The percentage of uncircumcised affected is the inverse of the number needed to treat value, which is the approximate number of males who need to be circumcised to prevent 1 case of each condition associated with lack of circumcision. Zorc et al, 18 Zorc J.J.

Kiddoo D.A.

Shaw K.N. Diagnosis and management of pediatric urinary tract infections. 19 Rushton H.G.

Majd M. Dimercaptosuccinic acid renal scintigraphy for the evaluation of pyelonephritis and scarring: a review of experimental and clinical studies. 20 Rushton H.G. Urinary tract infections in children: epidemiology, evaluation, and management. 21 Elder J.S. Urinary tract infections.

With concurrent bacteremia 20 2+ 0.1 d d The percentage of uncircumcised affected is the inverse of the number needed to treat value, which is the approximate number of males who need to be circumcised to prevent 1 case of each condition associated with lack of circumcision. Zorc et al, 18 Zorc J.J.

Kiddoo D.A.

Shaw K.N. Diagnosis and management of pediatric urinary tract infections. 19 Rushton H.G.

Majd M. Dimercaptosuccinic acid renal scintigraphy for the evaluation of pyelonephritis and scarring: a review of experimental and clinical studies. 20 Rushton H.G. Urinary tract infections in children: epidemiology, evaluation, and management. 21 Elder J.S. Urinary tract infections.

Hypertension in early adulthood – 2– 0.1 d d The percentage of uncircumcised affected is the inverse of the number needed to treat value, which is the approximate number of males who need to be circumcised to prevent 1 case of each condition associated with lack of circumcision. Jacobson et al, 22 Jacobson S.H.

Eklof O.

Eriksson C.G.

et al. Development of hypertension and uraemia after pyelonephritis in childhood: 27 year follow up.

End-stage renal disease in early adult – 2– 0.06 d d The percentage of uncircumcised affected is the inverse of the number needed to treat value, which is the approximate number of males who need to be circumcised to prevent 1 case of each condition associated with lack of circumcision. Jacobson et al, 22 Jacobson S.H.

Eklof O.

Eriksson C.G.

et al. Development of hypertension and uraemia after pyelonephritis in childhood: 27 year follow up.

Candidiasis 2.5 (1.7-3.7) 2+ 10 d d The percentage of uncircumcised affected is the inverse of the number needed to treat value, which is the approximate number of males who need to be circumcised to prevent 1 case of each condition associated with lack of circumcision. Richters et al, 23 Richters J.

Smith A.M.

de Visser R.O.

et al. Circumcision in Australia: prevalence and effects on sexual health.

Prostate cancer 1.2-2 2+ 2-10 d d The percentage of uncircumcised affected is the inverse of the number needed to treat value, which is the approximate number of males who need to be circumcised to prevent 1 case of each condition associated with lack of circumcision. Wright et al, 24 Wright J.L.

Lin D.W.

Stanford J.L. Circumcision and the risk of prostate cancer. 25 Morris B.J.

Waskett J.

Bailis S.A. Case number and the financial impact of circumcision in reducing prostate cancer. 26 Morris B.J.

Gray R.H.

Castellsague X.

et al. The strong protection afforded by circumcision against cancer of the penis. 27 Morris B.J.

Waskett J.H. Circumcision reduces prostate cancer risk.

Balanitis 3.1 (1.9-5.0) 1+ 10 d d The percentage of uncircumcised affected is the inverse of the number needed to treat value, which is the approximate number of males who need to be circumcised to prevent 1 case of each condition associated with lack of circumcision. Morris et al, 16 Morris B.J.

Waskett J.H.

Banerjee J.

et al. A “snip” in time: what is the best age to circumcise?.

Phimosis 100 1++ 10 d d The percentage of uncircumcised affected is the inverse of the number needed to treat value, which is the approximate number of males who need to be circumcised to prevent 1 case of each condition associated with lack of circumcision. Morris, 28 Morris B.J. Why circumcision is a biomedical imperative for the 21st century.

High-risk HPV infection 1.5 (1.1-2.0) 1++ 6 d d The percentage of uncircumcised affected is the inverse of the number needed to treat value, which is the approximate number of males who need to be circumcised to prevent 1 case of each condition associated with lack of circumcision. Tobian et al, 29 Tobian A.A.R.

Serwadda D.

Quinn T.C.

et al. Male circumcision for the prevention of HSV-2 and HPV infections and syphilis. 30 Auvert B.

Sobngwi-Tambekou J.

Cutler E.

et al. Effect of male circumcision on the prevalence of high-risk human papillomavirus in young men: results of a randomized controlled trial conducted in Orange Farm, South Africa.

2.7 (1.2-6.3) 1+ 10 d d The percentage of uncircumcised affected is the inverse of the number needed to treat value, which is the approximate number of males who need to be circumcised to prevent 1 case of each condition associated with lack of circumcision. Morris et al, 26 Morris B.J.

Gray R.H.

Castellsague X.

et al. The strong protection afforded by circumcision against cancer of the penis. 31 Castellsagué X.

Bosch F.X.

Munoz N.

et al. Male circumcision, penile human papillomavirus infection, and cervical cancer in female partners. 32 Miralles-Guri C.

Bruni L.

Cubilla A.L.

et al. Human papillomavirus prevalence and type distribution in penile carcinoma. 33 Albero G.

Castellsagué X.

Giuliano A.R.

Bosch F.X. Male circumcision and genital human papillomavirus: a systematic review and meta-analysis.

Herpes simplex virus type 2 1.4 (1.0-2.5) 1++ 4 d d The percentage of uncircumcised affected is the inverse of the number needed to treat value, which is the approximate number of males who need to be circumcised to prevent 1 case of each condition associated with lack of circumcision. Tobian et al, 29 Tobian A.A.R.

Serwadda D.

Quinn T.C.

et al. Male circumcision for the prevention of HSV-2 and HPV infections and syphilis. 34 Sobngwi-Tambekou J.

Taljaard D.

Lissouba P.

et al. Effect of HSV-2 serostatus on acquisition of HIV by young men: results of a longitudinal study in Orange Farm, South Africa. 35 Tobian A.A.R.

Charvat B.

Ssempijja V.

et al. Factors associated with the prevalence and incidence of herpes simplex virus type 2 infection among men in Rakai, Uganda.

1.1 (1.0-1.3) 1– 1 d d The percentage of uncircumcised affected is the inverse of the number needed to treat value, which is the approximate number of males who need to be circumcised to prevent 1 case of each condition associated with lack of circumcision. Weiss et al, 36 Weiss H.A.

Thomas S.L.

Munabi S.K.

Hayes R.J. Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta-analysis.

Genital ulcer disease 2.0 (1.4-2.3) 1+ 2 d d The percentage of uncircumcised affected is the inverse of the number needed to treat value, which is the approximate number of males who need to be circumcised to prevent 1 case of each condition associated with lack of circumcision. Gray et al, 37 Gray R.H.

Serwadda D.

Tobian A.A.R.

et al. Effects of genital ulcer disease and herpes simplex virus type 2 on the efficacy of male circumcision for HIV prevention: analyses from the Rakai trials.

Trichomonas vaginalis 1.9 (1.0-3.6) 1+ 0.5 d d The percentage of uncircumcised affected is the inverse of the number needed to treat value, which is the approximate number of males who need to be circumcised to prevent 1 case of each condition associated with lack of circumcision. Sobngwi-Tambekou et al, 38 Sobngwi-Tambekou J.

Taljaard D.

Nieuwoudt M.

et al. Male circumcision and Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis: observations in the aftermath of a randomised controlled trial for HIV prevention.

Mycoplasma genitalium 1.8 (1.0-3.4) 1++ 1 d d The percentage of uncircumcised affected is the inverse of the number needed to treat value, which is the approximate number of males who need to be circumcised to prevent 1 case of each condition associated with lack of circumcision. Mehta et al, 39 Mehta S.D.

Gaydos C.

Maclean I.

et al. The effect of medical male circumcision on urogenital Mycoplasma genitalium among men in Kisumu, Kenya.

Chancroid 0.1-1.1 1++ Low d d The percentage of uncircumcised affected is the inverse of the number needed to treat value, which is the approximate number of males who need to be circumcised to prevent 1 case of each condition associated with lack of circumcision. Weiss et al, 36 Weiss H.A.

Thomas S.L.

Munabi S.K.

Hayes R.J. Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta-analysis.

Syphilis 1.9 (1.2-2.9) 2+ Low d d The percentage of uncircumcised affected is the inverse of the number needed to treat value, which is the approximate number of males who need to be circumcised to prevent 1 case of each condition associated with lack of circumcision. Weiss et al, 36 Weiss H.A.

Thomas S.L.

Munabi S.K.

Hayes R.J. Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta-analysis.

HIV (acquired heterosexually) 2.4 (1.8-3.2) 1++ 0.3 d d The percentage of uncircumcised affected is the inverse of the number needed to treat value, which is the approximate number of males who need to be circumcised to prevent 1 case of each condition associated with lack of circumcision. Siegfried et al, 40 Siegfried N.

Muller M.

Deeks J.J.

Volmink J. Male circumcision for prevention of heterosexual acquisition of HIV in men. 41 Weiss H.A.

Halperin D.

Bailey R.C.

et al. Male circumcision for HIV prevention: from evidence to action [review]?. 42 Sansom S.L.

Prabhu V.S.

Hutchinson A.B.

et al. Cost-effectiveness of newborn circumcision in reducing lifetime HIV risk among U.S. males. 43 Morris B.J.

Bailey R.C.

Klausner J.D.

et al. Review: a critical evaluation of arguments opposing male circumcision for HIV prevention in developed countries.

Penile cancer (lifetime) >20 1++ 0.1 d d The percentage of uncircumcised affected is the inverse of the number needed to treat value, which is the approximate number of males who need to be circumcised to prevent 1 case of each condition associated with lack of circumcision. American Academy of Pediatrics, 14 American Academy of Pediatrics Task Force on Circumcision

Circumcision policy statement. 26 Morris B.J.

Gray R.H.

Castellsague X.

et al. The strong protection afforded by circumcision against cancer of the penis.

In female partner

Cervical cancer 2.4 (1.3-4.3) 2++ NA Castellsagué et al, 31 Castellsagué X.

Bosch F.X.

Munoz N.

et al. Male circumcision, penile human papillomavirus infection, and cervical cancer in female partners. 44 Bosch F.X.

Albero G.

Castellsagué X. Male circumcision, human papillomavirus and cervical cancer: from evidence to intervention.

Chlamydia trachomatis 5.6 (1.7-20) 2+ NA Castellsagué et al, 45 Castellsagué X.

Peeling R.W.

Franceschi S.

et al. Chlamydia trachomatis infection in female partners of circumcised and uncircumcised adult men.

Herpes simplex virus type 2 2.2 (1.4-3.6) 2+ NA Cherpes et al, 46 Cherpes T.L.

Meyne L.A.

Krohn M.A.

Hiller S.L. Risk factors for infection with herpes simplex virus type 2: role of smoking, douching, uncircumcised males, and vaginal flora.

Trichomonas vaginalis 1.9 (1.0-10) 1++ NA Gray et al, 47 Gray R.H.

Kigozi G.

Serwadda D.

et al. The effects of male circumcision on female partners' genital tract symptoms and vaginal infections in a randomized trial in Rakai, Uganda.

Bacterial vaginosis 1.7 (1.1-2.6) 1++ NA Gray et al, 47 Gray R.H.

Kigozi G.

Serwadda D.

et al. The effects of male circumcision on female partners' genital tract symptoms and vaginal infections in a randomized trial in Rakai, Uganda.

Risks associated with neonatal circumcision e e 14 American Academy of Pediatrics Task Force on Circumcision

Circumcision policy statement. 49 Wiswell T.E.

Geschke D.W. Risks from circumcision during the first month of life compared with those for uncircumcised boys. 50 Ben Chaim J.

Livne P.M.

Binyamini J.

et al. Complications of circumcision in Israel: a one year multicenter survey. These data show that risk of an easily treatable condition is approximately 1 in 200 and of a serious complication is 1 in 5000. Estimates are taken from American Academy of Pediatrics,

Local bruising at the site of injection of local anesthetic (if dorsal penile nerve block used) NA NA 25 f f Percentage affected is the inverse of the number needed to harm value, which is the approximate number of males who need to be circumcised to see one of each particular (mostly minor) adverse effect. The item “local bruising” is not included in the overall calculation of easily treatable risks because this phenomenon disappears naturally without any medical intervention. NA

Infection, local NA NA 0.2 f f Percentage affected is the inverse of the number needed to harm value, which is the approximate number of males who need to be circumcised to see one of each particular (mostly minor) adverse effect. The item “local bruising” is not included in the overall calculation of easily treatable risks because this phenomenon disappears naturally without any medical intervention. NA

Infection, systemic NA NA 0.02 f f Percentage affected is the inverse of the number needed to harm value, which is the approximate number of males who need to be circumcised to see one of each particular (mostly minor) adverse effect. The item “local bruising” is not included in the overall calculation of easily treatable risks because this phenomenon disappears naturally without any medical intervention. NA

Excessive bleeding NA NA 0.1 f f Percentage affected is the inverse of the number needed to harm value, which is the approximate number of males who need to be circumcised to see one of each particular (mostly minor) adverse effect. The item “local bruising” is not included in the overall calculation of easily treatable risks because this phenomenon disappears naturally without any medical intervention. NA

Need for repeat surgery (if skin bridges or too little prepuce is removed) NA NA 0.1 f f Percentage affected is the inverse of the number needed to harm value, which is the approximate number of males who need to be circumcised to see one of each particular (mostly minor) adverse effect. The item “local bruising” is not included in the overall calculation of easily treatable risks because this phenomenon disappears naturally without any medical intervention. NA

Loss of penis NA NA 0.0001 f f Percentage affected is the inverse of the number needed to harm value, which is the approximate number of males who need to be circumcised to see one of each particular (mostly minor) adverse effect. The item “local bruising” is not included in the overall calculation of easily treatable risks because this phenomenon disappears naturally without any medical intervention. NA

Death NA NA 0.00001 f f Percentage affected is the inverse of the number needed to harm value, which is the approximate number of males who need to be circumcised to see one of each particular (mostly minor) adverse effect. The item “local bruising” is not included in the overall calculation of easily treatable risks because this phenomenon disappears naturally without any medical intervention. NA