HIV and HSV-2 shedding and transmission in recently circumcised men.
With 33 million people infected with human immunodeficiency virus (HIV) and 2.7 million new infections annually, HIV/AIDS is also a leading cause of death worldwide. Randomized trials of male circumcision (MC) in Rakai, Uganda showed that MC prevents HIV and herpes simplex virus type 2 (HSV-2) acquisition in men. However, circumcision of HIV-positive men in a randomized controlled trial was not clear. The effect of MC on HSV-2 transmission to their female partners is unknown. We hypothesize that penile HIV and HSV-2 viral wound shedding increase immediately after MC leading to temporarily higher rates of HIV and HSV-2 transmission to female partners. Specifically, we will 1) evaluate whether MC of HIV-positive men increases penile HIV shedding and then decreases with wound healing and post-healing scar formation 2) determine whether MC of HSV-2 seropositive men temporarily increases penile HSV-2 shedding and 3) assess HSV-2 transmission to female partners by MC status. Through the trial and post-trial follow-up, we will utilize previously collected epidemiologic data, swabs collected weekly for two months from healing MC wounds, and plasma samples of male trial participants and their female partners. With rollout of MC throughout Africa (including following WHO recommendations that HIV-infected men should not be denied MC), the proposed studies are urgently needed to provide better programmatic guidance and develop improved strategies (e.g., short term antiretroviral therapy around the time of MC) to reduce HIV transmission to female partners.