Interpreting and dismissing the relevance of the “wait and wipe” finding from the circumcision studies conducted in Africa

Interpreting and dismissing the relevance of the “wait and wipe” finding from the circumcision studies conducted in Africa

This study characterises the prevalence of a broad spectrum of sexually transmitted diseases (STDs) (herpes simplex virus 2, syphilis, chlamydia, gonorrhoea), and examines associations between risk factors and infection in men working in Bangladesh’s trucking industry. But your partner should probably be operating under the assumption that you aren’t a virgin, and that therefore there is a risk. Taking a shower and using soap won’t hurt, but there isn’t any science to back it up that I know of. Can be transmitted by oral sex as well as by other forms of sexual intercourse (vaginal, anal). Herpes Simplex Virus Infections of the Central Nervous System. Sexually transmitted diseases (STDs) can cause emotional and physical discomfort. However a small percentage have it.

However, the penetration was very gentle. The various factors often lead to challenges in the design, implementation of HIV prevention studies as well as the interpretation of findings. For infection with any bacterial STD (syphilis, gonorrhoea, or chlamydia) the only significant risk factor was having sex with a commercial sex worker in the past year (OR=3.54; CI=1.29-9.72). The paper is not aimed at critiquing the way the studies were conducted but is merely aimed at reviewing some of the interesting findings and also at providing alternative views. While there were various and interesting findings from the previous studies, this paper only focuses on two secondary findings; uncircumcised men who waited for ten minutes after sexual intercourse and then wiped their penises using a dry cloth, had lower rates of HIV infection compared to those who cleaned using a wet cloth or those who cleaned within three minutes of having intercourse1; and men who became HIV infected despite having reported no sex or 100% condom use2. Herpes simplex virus (HSV) infections, syphilis, and chancroid account for almost all the STDs characterized by genital ulcers in the United States. Usually the first herpes simplex virus that people encounter, oral HSV-1, is typically spread simply by the kind of social kiss that a relative gives a child.

Many children contract oral herpes from their families while growing up. Specifically, the Uganda study commonly referred to as the Rakai Study, reported that men in the circumcised group got HIV at the rate of 0.66% per year compared to 1.33% per year for men in the uncircumcised group2. I kissed her mouth several times while I was with her (lips and tongue). The authors who reported this interesting finding however suggested caution in promoting any post-coital cleansing method as an alternative to male circumcision for HIV prevention in this specific rural setting1. The uncircumcised men who cleaned their penises within three minutes after sex had a higher rate of 2.32% per 100 person years while those who used water for cleaning at any time after sex also had a higher rate of 2.26% per 100 person years1. HIV incidence was higher among those reporting washing-alone (2.20/100 person years), than those reporting use of a cloth and washing (1.04/100 person years) and those using a cloth-alone (0.55/100 person years). These findings suggests that the uncircumcised men who waited for at least 10 minutes before wiping with a dry cloth experienced a significantly reduced risk of HIV infection compared to those that washed within 3 minutes of intercourse.

Hepatitis is also the name of a family of viral infections that affect the liver. Herpes simplex virus (HSV) infections are ubiquitous and have a wide range of clinical manifestations (see the images below). A vaccine for hepatitis A is available as well. One other commentator has opined that washing removes secretions from men that may have viral defenses3. However, I did not touch my penis while I still had any kind of wet bodily fluid on my fingers at this time. This interesting finding on waiting and wiping, has led to a growing body of anti-circumcision lobbyists who are calling for the wait and wipe strategy as an alternative to circumcision3–8. One of the anti-circumcision lobbyists suggests that the message to African men should be that they should not go for circumcision but should wait at least 10 minutes after sexual intercourse to clean their penises, and then simply clean by wiping using a dry cloth, without water, detergent or other fluid.

The lobbyist further suggests that programs to circumcise men and babies in Africa should be suspended pending further research on the impact of post-coital penile cleaning on HIV incidence3. Also interesting in the circumcision trials, was the finding that sixteen of the 67 incident infections recorded during the Rakai trial occurred in men who reported no sex (6 infections) or 100% condom use (10 infections)2. Have sex with only one other person whom you trust. The fact that diseases for which there are effective therapies that can be prevented by changing behavior are still rampant illustrates the complex nature of these diseases and the enormous challenges faced by the medical and public health communities in dealing with them. Screening can also reduce your risk of contracting an STD. This explanation however does not account for those who did not engage in any sexual activity as well as those who used condoms 100%. I don’t think it’s persisted for this long before though.
Interpreting and dismissing the relevance of the “wait and wipe” finding from the circumcision studies conducted in Africa

Regarding the ‘waiting and wiping’ finding, the interpretation that washing or wiping using a wet cloth removed some useful enzymes that are present in the vaginal secretions or sperms, excludes the role of the human factor in promoting the spreading of the HIV virus. This explanation also suggests that a significant proportion of infections occur after withdrawal. This explanation also does not take into cognizance the fact that coitus may take several minutes as well as some serious physical activity that may result in bruising, thereby creating opportunities for infection during the act. Rough sex, dry sex or forced sex often lead to friction, tears and bleeding. People who are very recently infected may test (falsely) negative for the disease, and should retest themselves after a period of some weeks. Because all sexually active people are at some risk of acquiring genital herpes, it is important to communicate with a sexual partner before the first sexual encounter. However, there are many types of cancer-causing HPV.

The discharges produced by many STIs contain a very high concentration of HIV virus if that person is also HIV positive. The wait and wipe lobbyists have not taken into consideration the very high prevalence of STI in high risk populations especially in African countries and we argue that the wait and wipe strategy is not a plausible strategy. We therefore find it both interesting and puzzling that waiting and wiping can be proposed as a strategy for prevention of HIV transmission and part of penile hygiene. In trying to take the human factor into the ‘wait and wipe finding’, we propose an alternative explanation. It is possible that those who washed their penises in less than three minutes did so out of fear – because they were aware that they had just had sex with a high-risk woman that they highly suspected was HIV infected. For example after a person has unprotected sex with a commercial sex worker, immediately after the sex act, they panic and rush to clean their penis using whatever is available including water and detergents – but the damage would already have been done. Hepatitis B can be spread by sexual intercourse and causes primarily liver diseases.

Infection with each herpesvirus produces distinctive clinical features and imaging abnormalities. Often severe pain during menses is a sign of a potentially treatable health problem. Such men, would clean their penises using dry cloth so as to remove the stickiness of the sperms and vaginal fluid and not out of fear of getting an STI. The cleaning after more than 10 minutes and the use of the dry cloth may not be coincidental after all. If one were to take this alternative interpretation seriously, it would therefore be premature for one to recommend the ‘wait and wipe’ strategy as an alternative to the circumcision HIV prevention strategy. In fact we argue that there is no need to conduct further research on the role of the waiting and the wiping using a dry cloth as it is simply a coincidental finding. Instead, it would have been useful to find out why some men cleaned within three minutes while some were not in a rush to clean their penises after sex.

What was the motive behind the cleaning? Anytime that you engage in unsafe sex practices with anyone you increase your risk for all STDs. The most common skin disorder identified was fungal infection, followed by eczema and seborrhoeic dermatitis (Box 21. Fibroids are not necessarily painful or problematic. The finding concerning the men who became HIV infected whilst using condoms 100% or those who report that they did not have any sexual encounter, is not only interesting but also baffling. The interpretation given about use of unsafe needles is certainly based on pure speculation. With all the campaigns on safe needles that have been going on, where on earth can one still find health professionals using unsafe needles?

Of all places, Uganda is one country which has taken some very positive and practical steps to ensure that HIV infections are minimized. For those who reported 100% condom use, there could be various other explanations including condoms breaking during the act, or starting the act without a condom and then wearing one mid-way or other practices such as finger sex or oral sex that the men did not report during the interviews due to various reasons. If one were to believe that these men got infected after truly abstaining or using condoms 100%, one may safely opine that perhaps some of the men had undetectable levels of virus in their bodies at the time of entry into the circumcision study. Sexually Transmitted Infections (STIs) are diseases that are passed on from one person to another through sexual contact. The viral levels then rose to detectable levels during the study. Your doctor can also refer you to a sex therapist for counseling. The possibility of an array of interpretations also implies the need to think wide when designing future HIV prevention trials.

It is undisputed that HIV prevention research presents some serious methodological and ethical challenges. It is also undisputable that HIV prevention research is essential. Rigour in design, implementation and interpretation will ensure that we get results that are more useful and not easily disputed. The above discussion has illustrated need for caution in the interpretation of findings. Biological interpretations that exclude the human behavioral element may not adequately explain some of these very interesting and yet tricky findings. Enema or rectal douching before rectal intercourse.

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