Longer-Term Follow-Up of Kenyan Men Circumcised Using the ShangRing Device
Paul J Feldblum, Jairus Okech, Rolex Ochieng, Catherine Hart, Grace Kiyuka, Jaim Jou Lai, Valentine Veena, Paul J Feldblum, Jairus Okech, Rolex Ochieng, Catherine Hart, Grace Kiyuka, Jaim Jou Lai, Valentine Veena
Abstract
Objectives: To ascertain clinical sequelae, client satisfaction and sexual behavior 2+ years after male circumcision using the ShangRing device.
Methods: We enrolled 199 men from the Kenya sites (Homa Bay district) participating in a 2012 study of the ShangRing device used in routine male circumcision services (N = 552). We enrolled men who had had the ShangRing placed successfully, and over-sampled men who had had an adverse event and/or were HIV-positive during the field study. In the present study, each participant was examined and interviewed by a study clinician, and penile photographs were taken to document longer-term cosmetic results and any abnormal findings.
Results: 194 men were included in the analysis. The mean and median times between circumcision and the longer-term follow-up visit in this study were 31.8 and 32 months, respectively. Four men (2.1%) had signs/symptoms of a sexually transmitted infection (STI). Virtually all (99.5%) of the men were very satisfied with the appearance of their circumcised penis, and all would recommend a ShangRing circumcision to friends or family members. The most prevalent reported advantage of the circumcision was the ease of bathing and enhanced cleanliness of the penis (75.8%). 94.3% of the men did not cite a single negative feature of their circumcision. 87.5% of men reported more sexual pleasure post-MC, the most common reason being more prolonged intercourse. The majority of men (52.6%) reported one sexual partner post-MC, but more than a quarter of the men (28.1%) reported an increased number of partners post-MC. Less than half of the men (44.3%) reported using condoms half of the time or more, but the great majority of condom users stated that condom use was much easier post-MC, and 76.9% of users said they used condoms more after circumcision than before.
Conclusions: This study supports the safety and acceptability of ShangRing male circumcision during 2-3 years of follow-up. It should allay worries that the ShangRing procedure could lead to delayed complications later than the observation period of most clinical studies.
Trial registration: ClinicalTrials.gov NCT01567436.
Conflict of interest statement
Competing Interests: The authors have declared that no competing interests exist.
Figures
References
- Gray R, Kigozi G, Kong X, Ssempiija V, Makumbi F, Wattya S, et al. The effectiveness of male circumcision for HIV prevention and effects on risk behaviors in a post-trial follow up study in Rakai, Uganda. AIDS 2012; 26:609–615.
- Mehta SD, Moses S, Agot K, Odoyo-June E, Li H, Maclean I, et al. The long-term efficacy of medical male circumcision against HIV acquisition. AIDS 2013; 27:2899–2907.
- Auvert B, Taljaard D, Rech D, Lissouba P, Singh B, Bouscaillou J et al. Association of the ANRS-12126 Male Circumcision Project with HIV levels among men in a South African township: evaluation of effectiveness using cross-sectional surveys. PLoS Med 2013; 10(9):e1001509.
- World Health Organization and UNAIDS. New Data on Male Circumcision and HIV Prevention: Policy and Programme Implications Conclusions and Recommendations of the WHO/UNAIDS Technical Consultation on Male Circumcision and HIV Prevention. WHO: Geneva, 2007. Available:
- Samuelson J, Baggaley R, Hirnschall G. Innovative device methods for adult medical male circumcision for HIV prevention: lessons from research. J Acquir Immune Defic Syndr 2013; 64:127–129.
- World Health Organization; WHO Prequalification of Male Circumcision Devices Public Report Product: PrePex; Number: PQMC 0001-001-00. WHO: Geneva, May 2013.
- World Health Organization; WHO Prequalification of Male Circumcision Devices Public Report Product: ShangRing; Number: PQMC 0003-003-00. WHO: Geneva, June 2015.
- World Health Organization; Guideline on the Use of Devices for Adult Male Circumcision for HIV Prevention. WHO: Geneva, October 2013.
- Sokal DC, Li PS, Zulu R, Awori QD, Agot K, Simba RO. et al. Field study of adult male circumcision using the ShangRing in routine clinical settings in Kenya and Zambia. J Acquir Immune Defic Syndr 2014; 67:430–437.
- Barone MA, Li PS, Awori QD, Lee R, Goldstein M. Clinical trials using the Shang Ring device for male circumcision in Africa: a review. Transl Androl Urol 2014; 3:113–124.
- Krieger JN, Mehta SD, Bailey RC, Agot K, Ndinya-Achola J, Parker C, et al. Adult male circumcision: effects on sexual function and sexual satisfaction in Kisumu, Kenya. J Sex Med 2008; 11:2610–2622.
- Morris BJ, Krieger JN. Does male circumcision affect sexual function, sensitivity, or satisfaction? A systematic review. J Sex Med 2013; 10:2644–2657.
- Yue C, Kerong W, Zejun Y, Shuwei Y, Fang L, Xinjun S. Long-term follow-up for Shang Ring male circumcision. Chin Med J 2014; 127:1879–1883.
- Cao D, Liu L, Hu Y, Wang J, Yuan J, Dong Q, et al. A systematic review and meta-analysis of circumcision with Shang Ring vs conventional circumcision. Urology 2015; accessed at: doi:
Source: PubMed