Men who are circumcised are less likely to get sexually transmitted infections such as genital herpes and human papillomavirus (HPV), but not syphilis, according to a study of adult African men published this week in the New England Journal of Medicine.



Circumcision rates have traditionally been higher in the U.S. than in Europe, but they've been on the decline.



The finding adds to the evidence that there are health benefits to circumcision. It was already known that circumcision can reduce the risk of penile cancer, a relatively rare disease. In a previous study, the same research team found that adult circumcision could reduce the risk of HIV infection.



Efforts to increase the practice of male circumcision in areas with high rates of sexually transmitted infections, including Africa, could have a tremendous benefit, say the study's authors. Genital herpes has been associated with an increased risk of HIV, and HPV can cause genital warts as well as a higher risk of anal, cervical (in women), and penile cancers. Health.com: Is your partner cheating? How to protect yourself



In the United States, infant circumcision is declining. About 64 percent of American male infants were circumcised in 1995, down from more than 90 percent in the 1970s. Rates tend to be higher in whites (81percent) than in blacks (65 percent) or Hispanics (54 percent).



Some opponents say the removal of the foreskin is an unnecessary surgical procedure that may reduce sexual sensitivity in adulthood. In Jewish and Muslim cultures, young or infant boys are routinely circumcised for religious reasons. Circumcision rates have traditionally been higher in the U.S. than in Europe, but the American Academy of Pediatrics currently says that the medical benefits are insufficient to recommend circumcision for all baby boys.



In the new study, a research team at the Rakai Health Sciences Program in Uganda -- in collaboration with researchers from the Johns Hopkins University Bloomberg School of Public Health in Baltimore, Maryland, and Makerere University in Uganda -- conducted two clinical trials involving 3,393 uncircumcised men ages 15 to 49. All the men were negative for HIV and genital herpes (also known as herpes simplex virus type 2); a subgroup of men also tested negative for HPV.



Roughly half of the men underwent medically supervised circumcision at the start of the trial, while the other half were circumcised two years later.



Overall, circumcision reduced the men's risk of genital herpes by 28 percent (10.3 percent of uncircumcised men developed genital herpes compared with 7.8 percent of circumcised men) and HPV infection by 35 percent (27.8 percent of uncircumcised men were infected with HPV compared with 18 percent of circumcised men). Circumcision did not, however, protect against syphilis. (About 2 percent of men in both groups contracted syphilis.) Health.com: A sexual risk taker comes to terms with drinking, depression, and STDs



Study coauthor Thomas C. Quinn, M.D., professor of global health at Johns Hopkins University, says that choosing circumcision, whether it's the parents of an infant or an adult male for himself, is and should remain an individual decision.



"But the critics need to really look at the benefits versus the risks," he adds. "By now a large body of evidence has shown that the health benefits clearly outweigh the minor risk associated with the surgery. In our study, we didn't see any adverse effects or mutilation. We're recommending supervised, safe, sterile environments -- not circumcision out in an open field with rusty instruments."



Increasing circumcision rates in Africa may not only help men, but would likely protect women too, possibly lowering the rates of female cervical cancer, the authors say. Ronald H. Gray, M.D., professor of public health at Johns Hopkins University and study coauthor, says that the researchers plan to look at whether male circumcision reduces the transmission of HPV to female sexual partners. Health.com: 10 questions to ask a new partner before having sex



Even in the United States, this study has relevance, says Anthony Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases (which funded one of the trials).



"In this country, circumcision for
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