• It is uncertain whether male circumcision (MC) reduces the risk of syphilis among men and women

• Partners PrEP Study data (n=4,716) analyzed to assess association of MC with incident syphilis in men and women

• RPR titer change of >4-fold with a Treponema pallidum–specific confirmatory result defined incident case

• MC status determined by physical examination and analyzed as time-varying

• 221 incident syphilis infections observed (99 in women, 122 in men)

B a c k g r o u n d & M e t h o d s

Male circumcision and the incidence of syphilis acquisition among male and female partners of HIV-1 serodiscordant heterosexual

African couples: a prospective study

Jillian Pintye1, Jared Baeten1, Lisa Manhart1, Connie Celum1, Allan Ronald2,3, Nelly Mugo1,4, Andrew Mujugira1, Craig Cohen4,5, Edwin Were6, Elizabeth Bukusi4,5, James Kiarie1,7, Renee Heffron1

For the Partners PrEP Study Team1University of Washington, 2University of Manitoba, 3Makerere University, 4 Kenya Medical Research Institute, 5University of

California-San Francisco, 6Moi University, 7University of Nairobi

No conflicts of interest to disclose

I n c i d e n t S y p h i l i s & R i s k R e d u c t i o n

Adj Hazard Ratio1 p-value

0.58 (0.37-0.91) 0.017

0.38 (0.18-0.81) 0.013

0.64 (0.36-1.11) 0.115

0.41 (0.25-0.69) 0.001

0.52 (0.27-0.97) 0.040

0.25 (0.08-0.76) 0.014

Incidence rate (per 100 person-years)

1Adjusted for age, sexual behavior, and plasma HIV-1 RNA levels of HIV-1 infected partner

Uncircumcised male partnersCircumcised male partners

HIV-1 uninfected women (n=1643)

Uncircumcised male partnersCircumcised male partners

HIV-1 infected women (n=2773)

Uncircumcised male partnersCircumcised male partners

All women (n=4416)

UncircumcisedCircumcised

HIV-1 uninfected men (n=2744)

UncircumcisedCircumcised

HIV-1 infected men (n=1645)

UncircumcisedCircumcised

All men (n=4389)

0.00 0.20 0.40 0.60 0.80 1.00 1.20 1.40 1.60

1.480.43

1.080.54

1.27

0.51

1.38

0.89

1.420.54

1.400.80

L i m i t a t i o n s I m p l i c a t i o n s

A c k n o w l e d g e m e n t s We are grateful to the couples who participated in this study

University of Washington Coordinating Center and Central Labs: Connie Celum, Jared M. Baeten, Deborah Donnell, Robert W. Coombs, Lisa Frenkel, Craig W. Hendrix,

Jairam Lingappa, M. Juliana McElrath.

Site teams and partners: Kenneth Fife, Edwin Were (Eldoret, Kenya); Elioda Tumwesigye (Kabwohe, Uganda); Patrick Ndase, Elly Katabira (Jinja,

Uganda); Elly Katabira, Allan Ronald (Kampala, Uganda); Elizabeth Bukusi, Craig Cohen (Kisumu, Kenya); Jonathan Wangisi, James Campbell, Jordan Tappero (Mbale, Uganda); James Kiarie, Carey Farquhar, Grace John-Stewart (Nairobi, Kenya);

Nelly Rwamba Mugo (Thika, Kenya); James Campbell, Jordan Tappero, Jonathan Wangisi (Tororo, Uganda); DF/Net Research, Inc. (Data management); Contract Laboratory Services (Laboratory management); Gilead Sciences (Study drug

donation)

Funding was provided by the Bill and Melinda Gates Foundation (research grant OPP47674) and the National Institute of Child Health and Development (grants K99HD076679). Travel funds provided by the International AIDS Society

• Annual assessment of syphilis and MC status

• Absence of laboratory testing to link syphilis infections

• MC associated with decreased risk of syphilis in men and women

• MC may have benefits for syphilis prevention that expand its impact