by Mike Andrew - SGN Staff Writer

The decline in circumcisions means a higher risk for sexually transmitted diseases, according to a new study by Johns Hopkins University researchers. The report was published in the Archives of Pediatrics and Adolescent Medicine.

About 55% of the two million males born in the U.S. every year are circumcised, a dramatic decrease from 79% in the 1980s. Because bacteria and viruses can accumulate under the foreskin, circumcision is believed to lower the risk of STDs like HIV/AIDS, herpes, genital warts, and genital cancers.

As a result, circumcision has been promoted as a low-cost, low-risk preventive measure in Africa and other Third World areas, where sexually transmitted infections have reached epidemic proportions. It has gotten less attention in the U.S., where 18 state Medicare programs have dropped coverage of the procedure and private insurers have followed, researchers said.

'States' efforts to reduce current costs by eliminating Medicaid coverage for male circumcision are penny-wise and pound-foolish,' Arleen Leibowitz and Katherine Desmond of UCLA's Center for HIV Identification, Prevention, and Treatment Services wrote in an editorial accompanying the Johns Hopkins study.

'Investing today in a relatively low-cost procedure will avert greater future treatment costs for cancer, HIV, and other STIs,' they wrote, calling on the federal government to reclassify the procedure as a mandatory service.

'Indeed, the groups that Medicaid covers are precisely those that experience the greatest prevalence of HIV and other STIs, which male circumcision can effectively avert,' Leibowitz and Desmond wrote.

CULTURAL BARRIERS REMAIN
'If there were a vaccine that reduced HIV infection, genital herpes and warts, penile cancer, cervical cancer, and bacterial vaginosis, it would be promoted as a game-changing intervention and all physicians would encourage their patients to get it,' Johns Hopkins epidemiologist Aaron Tobian said.

'The difference is this is a surgery with very minor complications, and it also has a cultural tone to it.'

Johns Hopkins health economists said U.S. health care costs might increase by $4.4 billion in the next decade if U.S. circumcision rates plunge to the level of Europe, where only 10% of boys are circumcised.

Every time a circumcision is avoided, $313 is added in direct illness-related expenses, not counting the cost of the procedure, Tobian said.

'All state Medicaid and private insurers should cover male circumcision and we should eliminate all of the current barriers. Families should discuss the risks and benefits of the procedure with their physicians and decide what is best for them,' he recommended.

Tobian criticized the American Academy of Pediatrics, which is currently reviewing its policy on circumcision. The academy does not recognize any of the health benefits linked to the procedure, despite overwhelming evidence, he said.

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