Reply #59: There have been many UTI studies. Interestingly, however, the Academy

[pnwmom]

made another change in position several years ago, this time swinging back in your direction. However, according to this article in the Journal of the American Academy of Pediatrics, the new policy is not backed up by the research.

http://pediatrics.aappublications.org/cgi/content/full/105/3/620

New Policy on CircumcisionCause for Concern

Edgar J. Schoen, MD*, Thomas E. Wiswell, MD, and Stephen Moses, MD§

From the Departments of * Pediatrics and Genetics, Kaiser Permanente Medical Center, Oakland, California; Departments of Pediatrics and Neonatology, Thomas Jefferson University, Philadelphia, Pennsylvania; and Department of § Medical Microbiology, Community Health Sciences and Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.

(Note that one of the authors is at an HMO, which has a vested interest in good preventative medicine.)


"The negative conclusions on newborn circumcision drawn by the recent American Academy of Pediatrics (AAP) Task Force on Circumcision are misleading and contrary to the current medical evidence, including data in the body of the report itself1 and in the references cited therein. As professionals closely involved with clinical investigations on newborn circumcision,2-7 we are compelled to express our concern about this report. The Task Force states that newborn circumcision is not recommended and that the procedure is "not essential to the child's current well-being."1 The media and the public are now understandably convinced that the AAP has adopted an anticircumcision stance compared with its previous neutral position on newborn circumcision.2 This attitude has not only been taken by the activist anticircumcision forces but also by the respected media: eg, "Circumcision Loses a Key Endorsement" (Washington Post),8 "Circumcision Benefits Disputed" (Chicago Sun-Times),9 "Pediatricians Turn Away From Circumcision" (CNN),10 and "Circumcision Opponents Energized by About-Face of Academy of Pediatrics" (Forward).11 One would assume that in the decade since the 1989 report,2 new evidence must have appeared demonstrating substantial disadvantage of newborn circumcision. However, the opposite is true.

"Considerable published data from the past 10 years (much of it cited in the current report) confirm and reinforce previous evidence on the medical benefits of newborn circumcision, particularly in protecting against urinary tract infection (UTI) and human immunodeficiency virus (HIV) infection. Pain a major disadvantage of the procedure has been shown to be safely and effectively controlled by local anesthesia. With more proven advantages and fewer disadvantages, how could the Task Force issue a statement that could only be interpreted as reversing previous policy and discouraging newborn circumcision?

"The report of the 1989 Task Force, for which 1 of the authors (E.J.S.) was Chair,2 listed definitive benefits of newborn circumcision: prevention of 3 specific conditions (penile cancer, local infection, and phimosis) and facilitation of good genital hygiene. In addition, we found credible evidence that newborn circumcision prevents UTI in the first year of life.4 Published articles describing a preventive effect on HIV acquisition12,13 were considered preliminary and not included in the report. Disadvantages listed were pain and possible infection and bleeding. In the ensuing 10 years, the protective effect of newborn circumcision on UTI in infants has been repeatedly confirmed,5 and worldwide epidemiologic studies have presented compelling evidence of the protective effect against HIV acquisition.6

"Multiple studies14 comparing the prevalence of UTI in uncircumcised and circumcised male infants have shown a preponderance of UTI in uncircumcised infants. While a meta-analysis described a 12-fold increase for UTIs,14 the 1999 Task Force statement suggests the protective effect of circumcision is less (3- to 7-fold), inappropriately citing among others, the works of Shaw et al,15 Herzog,16 and Fussell et al.17 In reality, the study by Shaw et al yielded an 8-fold increased risk, the Herzog investigation demonstrated a greater than 50-fold increased risk, and the Fussell report did not even address the issue. It seems likely that the prevalence of UTI is higher than reported because it will be underdiagnosed unless urine cultures are routinely taken in evaluating febrile infants. Newman et al,18 reporting for the Pediatric Research in an Office Setting network, concluded that fewer than 50% of pediatricians performed urine culture in evaluating febrile infants <3 months old, despite the high incidence of UTI (>10%) in these infants. In a population-based study of 14 893 males born in 1996 in a closed-panel, nonprofit health maintenance organization with an effective tracking system, 2.5% (1 in 40) of uncircumcised infants developed UTI within the first year of life, most before 6 months old, and were 11 times more likely to develop UTI and 18 times more likely to be hospitalized with UTI than were circumcised infants.19 The subsequent development of renal scarring indicates that UTI in infancy may not be benign.20 As stated in "Information for Parents,"21 evidence indicates that in the first year of life uncircumcised infants have at least a 10-fold increased risk of UTI; a circumcised infant has approximately a 1 in 1000 chance of having UTI in the first year of life, whereas an uncircumcised infant has a 1 in 100 chance. In clinical terms, given that ~2 million boys are born each year in the United States, this 10-fold risk of UTI translates into 20 000 UTIs annually in the United States if all newborn boys are uncircumcised but only 2000 UTIs annually if all the boys are circumcised. Otherwise stated, newborn circumcision is >90% effective for preventing UTI, a preventive health benefit equivalent to the protective rate of many vaccines given to children.22 Despite this implication, however, the 10-fold relative risk for UTI in uncircumcised:circumcised is referred to as a "slightly lower risk."1"

SNIP

Renal scarring is a serious issue. So is invasive penile cancer, which, according to this article, would triple to more than 3,000 cases per year in the event that circumcision were completely eliminated. The article talks about other research in detail. You might want to read it.