Date of Award

2014

Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant

Department Chair

John Cavenagh, PhD, PA-C

Abstract

OBJECTIVE: The objective of this selective EBM review is to determine whether or not male circumcision prevents herpes simplex virus type 2 (“HSV-2”) in sexually active males aged 18- 50.

STUDY DESIGN: Review of three English language primary studies published in 2009 and 2012.

DATA SOURCES: Three randomized control trials analyzing the intervention of circumcision to prevent HSV-2 in sexually active males found using Medline and PubMed.

OUTCOMES MEASURED: The main clinical outcome in all studies measured the incidence of HSV-2 defined as a sexually transmitted infection with symptoms of visible genital ulceration. The outcomes were measure by patient self-report of symptoms, nurse examination, and serum samples tested for the HSV-2 antibody utilizing the Kalon Biological assay. Mahiane et al. additionally measured the spread of HSV-2 from female to male partners, calculated via selfreport of patients’ sexual behavior including number of partners as a function of time and number of sexual contacts with each partner.

RESULTS: In the study by Mehta et al., circumcision was not statistically significant (p = 0.655) in preventing HSV-2. In the study by Tobian et al., statistical significance was proven (p= 0.008) in the intervention group receiving circumcision. In the study by Mahiane et al., circumcision was also found to be statistically significant in preventing HSV-2 per sex act (p= 0.005) and per partnership (p=0.001).

CONCLUSIONS: The results of two RCTs show circumcision to be an effective intervention in the prevention of HSV-2. Because one trial does not reach statistical significance, the overall results are inconclusive. In order to improve further research, a larger age and geographical population should be recruited.

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