{"id":1593,"date":"2020-09-04T08:00:00","date_gmt":"2020-09-04T01:00:00","guid":{"rendered":"https:\/\/drsoaraweeurology.com\/?p=1593"},"modified":"2026-08-15T00:21:24","modified_gmt":"2026-08-14T17:21:24","slug":"la-circoncisione-riduce-lhiv","status":"publish","type":"post","link":"https:\/\/drsoaraweeurology.com\/it\/2020\/09\/04\/circumcision-reducing-hivs\/","title":{"rendered":"Circumcision and HIV: Why the Foreskin Matters, and What the 60\u201370% Figure Really Means"},"content":{"rendered":"\n<div class=\"wp-block-columns coblocks-author-columns has-background is-layout-flex wp-container-core-columns-is-layout-52275889 wp-block-columns-is-layout-flex\" style=\"background-color:#8C8C971A;padding-top:2.5rem;padding-right:2.5rem;padding-bottom:2.5rem;padding-left:2.5rem\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:25%\">\n<figure class=\"wp-block-image size-full is-style-rounded\"><img data-recalc-dims=\"1\" fetchpriority=\"high\" decoding=\"async\" width=\"800\" height=\"800\" data-attachment-id=\"7037\" data-permalink=\"https:\/\/drsoaraweeurology.com\/it\/new-photo-2024\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?fit=800%2C800&amp;ssl=1\" data-orig-size=\"800,800\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"Dr. Soarawee Weerasopone \u2014 Board-Certified Urologist in Bangkok, Thailand\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;Dr. Soarawee Weerasopone \u2014 Board-Certified Urologist in Bangkok, Thailand&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?fit=800%2C800&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=800%2C800&#038;ssl=1\" alt=\"Dr. Soarawee Weerasopone \u2014 Board-Certified Urologist in Bangkok, Thailand\" class=\"wp-image-7037\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?w=800&amp;ssl=1 800w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=300%2C300&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=150%2C150&amp;ssl=1 150w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=768%2C768&amp;ssl=1 768w, 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4.022-2.484 4.022-3.722 0-2.016-1.284-3.722-4.097-3.722h-2.222z\"\/>\n    <\/svg>\n  <\/a>\n  \n  <a href=\"https:\/\/scholar.google.com\/citations?user=lTgsRMUAAAAJ&#038;hl=en\" \n     target=\"_blank\" \n     rel=\"noopener\"\n     title=\"Google Scholar\"\n     aria-label=\"View Google Scholar Profile\"\n     style=\"text-decoration: none; color: #4285F4; transition: transform 0.2s; display: inline-block;\"\n     onmouseover=\"this.style.transform='scale(1.15)'\"\n     onmouseout=\"this.style.transform='scale(1)'\">\n    <svg width=\"28\" height=\"28\" viewBox=\"0 0 24 24\" fill=\"currentColor\">\n      <path d=\"M5.242 13.769L0.5 9.5 12 1l11.5 8.5-4.742 4.269C17.548 11.249 14.978 9.5 12 9.5c-2.977 0-5.548 1.748-6.758 4.269zM12 10a7 7 0 1 0 0 14 7 7 0 0 0 0-14z\"\/>\n    <\/svg>\n  <\/a>\n  \n<\/div>\n\n\n\n<p class=\"has-drop-cap wp-block-paragraph\">Worry about HIV after unprotected sex is one of the most distressing things men bring to my clinic. Everyone knows condoms protect against HIV. Fewer people know that circumcision has a protective effect too \u2014 and fewer still know exactly what that protection covers and what it does not.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>If you are reading this because a possible exposure happened in the last few days, start here rather than with the rest of the article.<\/strong> Post-exposure prophylaxis (PEP) is a course of antiretroviral medication that can substantially reduce the chance of infection, but it has to be started as soon as possible and <strong>within 72 hours<\/strong> of the exposure \u2014 the earlier the better. Go to an emergency department or an infectious diseases service now; at Bangkok Hospital, HIV testing, PEP and PrEP are handled by Infectious Diseases rather than by the urology clinic. Nothing on this page is useful after an exposure has already happened: circumcision is a long-term measure and does nothing retrospectively.<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><img data-recalc-dims=\"1\" decoding=\"async\" width=\"800\" height=\"534\" data-attachment-id=\"1600\" data-permalink=\"https:\/\/drsoaraweeurology.com\/it\/2020\/09\/04\/circumcision-reducing-hivs\/latex-condom-on-white-background\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2020\/09\/Condom.jpg?fit=1000%2C668&amp;ssl=1\" data-orig-size=\"1000,668\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;10&quot;,&quot;credit&quot;:&quot;Mateus Andre&quot;,&quot;camera&quot;:&quot;NIKON D750&quot;,&quot;caption&quot;:&quot;Latex condom on white background&quot;,&quot;created_timestamp&quot;:&quot;1593892777&quot;,&quot;copyright&quot;:&quot;Mateus Andre&quot;,&quot;focal_length&quot;:&quot;85&quot;,&quot;iso&quot;:&quot;500&quot;,&quot;shutter_speed&quot;:&quot;0.0125&quot;,&quot;title&quot;:&quot;Latex condom on white background&quot;,&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"We have already known that condom is one of the best protection on HIV\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;We have already known that condom is one of the best protection on HIV&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2020\/09\/Condom.jpg?fit=800%2C534&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2020\/09\/Condom.jpg?resize=800%2C534&#038;ssl=1\" alt=\"Condoms, the most effective barrier protection against HIV transmission\" class=\"wp-image-1600\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2020\/09\/Condom.jpg?w=1000&amp;ssl=1 1000w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2020\/09\/Condom.jpg?resize=300%2C200&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2020\/09\/Condom.jpg?resize=768%2C513&amp;ssl=1 768w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">Condoms remain the single most effective protection against HIV.<\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Circumcision has clear medical value in its own right \u2014 for phimosis, where the foreskin cannot be retracted, and for recurrent bacterial infection of the foreskin. What surprises most patients is the HIV finding on top of that.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/27200126\/\">Several high-quality studies<\/a> report a <strong>60\u201370% reduction in HIV transmission<\/strong> in circumcised compared with uncircumcised men. That result is what pushed researchers to work out why \u2014 and the answer is that the foreskin itself is a major route of entry.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Read that figure carefully, though.<\/strong> It comes from trials of <strong>female-to-male transmission during vaginal sex<\/strong>. It does not describe protection for the female partner, and the evidence does not support the same protection for men who have sex with men, where the transmission route is different. It is a reduction in risk, not a shield \u2014 and it makes no difference at all to transmission through blood or needles.<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><img data-recalc-dims=\"1\" decoding=\"async\" width=\"800\" height=\"933\" data-attachment-id=\"1601\" data-permalink=\"https:\/\/drsoaraweeurology.com\/it\/2020\/09\/04\/circumcision-reducing-hivs\/close-up-diagram-for-hiv-virus\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2020\/09\/HIV.jpg?fit=1000%2C1166&amp;ssl=1\" data-orig-size=\"1000,1166\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;Close up diagram for HIV virus illustration&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;Close up diagram for HIV virus&quot;,&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"HIV issue always upset patients whom possibly infect\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;HIV issue always upset patients whom possibly infect&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2020\/09\/HIV.jpg?fit=800%2C933&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2020\/09\/HIV.jpg?resize=800%2C933&#038;ssl=1\" alt=\"HIV testing, the source of anxiety that brings many men to a urology clinic\" class=\"wp-image-1601\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2020\/09\/HIV.jpg?w=1000&amp;ssl=1 1000w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2020\/09\/HIV.jpg?resize=257%2C300&amp;ssl=1 257w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2020\/09\/HIV.jpg?resize=878%2C1024&amp;ssl=1 878w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2020\/09\/HIV.jpg?resize=768%2C895&amp;ssl=1 768w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">Fear of HIV after an unprotected encounter is a common reason men seek advice.<\/figcaption><\/figure>\n\n\n\n<h4 class=\"wp-block-heading\">Three reasons the foreskin is the weak point<\/h4>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>HIV&#8217;s target cells are concentrated there.<\/strong> The primary target for HIV is the Langerhans cell, a type of white blood cell that is particularly dense in the inner foreskin. Circumcision removes that tissue \u2014 and with it, the highest concentration of cells the virus is looking for.<\/li>\n\n\n\n<li><strong>The skin barrier there is thinner.<\/strong> The inner foreskin has fewer keratinised protective layers than the rest of the penile skin, making it far more permeable to the virus. It is also prone to micro-abrasions and small tears during sex, and each of those is a direct entry point.<\/li>\n\n\n\n<li><strong>The local bacteria make things worse.<\/strong> The normal flora living under the foreskin produce pro-inflammatory substances that draw immune cells to the area \u2014 bringing HIV and its target cells into easier contact and amplifying the risk further.<\/li>\n<\/ol>\n\n\n\n<p class=\"wp-block-paragraph\">Taken together, these explain why the foreskin punches so far above its weight in HIV transmission, and why removing it changes the odds so much.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>None of this replaces a condom.<\/strong> Circumcision reduces risk substantially; a condom used consistently reduces it far more, and covers the situations circumcision does not. The sensible position is to treat circumcision as one layer among several \u2014 alongside condoms, regular STI screening and knowing your partner&#8217;s status \u2014 rather than as a reason to relax about any of them. If you want to weigh it up for yourself, that is a conversation to have with a urologist, and the <a href=\"https:\/\/drsoaraweeurology.com\/2020\/10\/30\/circumcision-most-suitable-op\/\">surgical techniques are compared here<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">It is also worth saying plainly that circumcision is an operation, not a vaccine. It carries the usual surgical risks of bleeding, infection and an imperfect cosmetic result, and there is a healing period of several weeks during which sex should be avoided \u2014 and during which the wound itself may make transmission easier rather than harder. Anyone choosing it for protective reasons should weigh those against a measure that only shifts the odds.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If you are considering adult circumcision for medical, protective, or personal reasons, Dr. Soarawee Weerasopone offers specialist consultations at Bangkok Hospital Headquarters. <a href=\"https:\/\/www.bangkokhospital.com\/en\/bangkok\/doctor\/dr-soarawee-weerasopone-2\">Book a Consultation<\/a>. Appointments at Samitivej Sriracha Hospital can be arranged by calling the Urology department on <a href=\"tel:0880221445\">088-022-1445<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Bangkok Hospital also runs a Telemedicine service for patients who cannot attend in person, including international patients \u2014 arrange it in advance by email to the Urology department at <a href=\"mailto:bhquro@bdms.co.th\">bhquro@bdms.co.th<\/a>. Samitivej Sriracha is in-person only. A recent possible HIV exposure is not a telemedicine matter: that needs same-day assessment in person.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Frequently Asked Questions about Circumcision and HIV Prevention<\/h2>\n\n\n\n<div class=\"schema-faq wp-block-yoast-faq-block\"><div class=\"schema-faq-section\" id=\"faq-question-1\"><strong class=\"schema-faq-question\">Does circumcision really reduce the risk of HIV infection?<\/strong> <p class=\"schema-faq-answer\">Yes. Multiple high-quality studies have shown that male circumcision reduces the risk of HIV transmission by 60&#8211;70% in heterosexual men, specifically female-to-male transmission during vaginal sex. The protective effect is attributed to the removal of the inner foreskin, which contains a high density of HIV-susceptible Langerhans cells, has a thinner skin barrier, and is prone to micro-tears during intercourse. The evidence does not show the same protection for men who have sex with men, or for the female partner.<\/p><\/div> <div class=\"schema-faq-section\" id=\"faq-question-2\"><strong class=\"schema-faq-question\">Why is the inner foreskin such a high-risk site for HIV transmission?<\/strong> <p class=\"schema-faq-answer\">The inner foreskin tissue has three characteristics that make it particularly vulnerable to HIV. First, it is densely populated with Langerhans cells, which are the primary target cells for HIV entry. Second, it has fewer keratinized (protective) skin layers than other penile tissue, making it more permeable. Third, it is prone to abrasions and micro-tears during sexual activity, creating direct entry points for the virus.<\/p><\/div> <div class=\"schema-faq-section\" id=\"faq-question-3\"><strong class=\"schema-faq-question\">Can circumcision replace condom use for HIV prevention?<\/strong> <p class=\"schema-faq-answer\">No. Circumcision significantly reduces but does not eliminate HIV transmission risk, and it offers no protection at all against transmission through blood or needles. It should be considered a complementary preventive measure, not a replacement for condoms. The most effective strategy combines consistent condom use, circumcision, safe sexual behavior, and regular STI screening &#8211; especially for men in high-prevalence settings.<\/p><\/div> <div class=\"schema-faq-section\" id=\"faq-question-4\"><strong class=\"schema-faq-question\">What other STIs does circumcision help protect against?<\/strong> <p class=\"schema-faq-answer\">Beyond HIV, there is evidence that circumcision reduces the risk of HPV (human papillomavirus) infection, and weaker evidence of a reduction in genital herpes (HSV-2) and syphilis. It also lowers the lifetime risk of phimosis, recurrent balanitis, and penile cancer, which is a rare disease to begin with. None of these effects is large enough to change safer-sex practice, and circumcision does not protect against chlamydia or gonorrhoea.<\/p><\/div> <div class=\"schema-faq-section\" id=\"faq-question-5\"><strong class=\"schema-faq-question\">Is it too late to get circumcised as an adult for HIV protection?<\/strong> <p class=\"schema-faq-answer\">No. Adult circumcision provides the same protective benefits as circumcision performed earlier in life. The procedure can be safely performed under local anesthesia as an outpatient procedure. Bear in mind it is still surgery, with the usual risks of bleeding and infection and a healing period of several weeks during which sex should be avoided. If you are considering circumcision for medical, protective, or personal reasons, a consultation with a urologist will help you assess the options and choose the most appropriate surgical technique.<\/p><\/div> <div class=\"schema-faq-section\" id=\"faq-question-6\"><strong class=\"schema-faq-question\">I may have been exposed to HIV in the last few days &#8211; what should I do?<\/strong> <p class=\"schema-faq-answer\">Seek care immediately. Post-exposure prophylaxis (PEP) is a course of antiretroviral medication that can substantially reduce the chance of infection, but it must be started as soon as possible and within 72 hours of the exposure. Go to an emergency department or an infectious diseases service &#8211; at Bangkok Hospital, HIV testing, PEP and PrEP are provided by Infectious Diseases, not by the urology clinic. Circumcision has no role once an exposure has occurred.<\/p><\/div><\/div>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Disclaimer:<\/strong> This content is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters. It is intended for educational purposes only and does not constitute medical advice. Circumcision reduces but does not eliminate the risk of HIV transmission and is not a substitute for condoms or other preventive measures. A possible HIV exposure within the last 72 hours is time-critical and needs immediate in-person assessment by an emergency or infectious diseases service. No medical advice, diagnosis or prescription is provided through personal messaging channels. Always consult a qualified healthcare professional before starting any medical treatment.<\/p>\n\n\n\n<script type=\"application\/ld+json\">\n{\n  \"@context\": \"https:\/\/schema.org\",\n  \"@graph\": [\n    {\n      \"@type\": \"MedicalWebPage\",\n      \"@id\": \"https:\/\/drsoaraweeurology.com\/2020\/09\/04\/circumcision-reducing-hivs\/#medicalwebpage\",\n      \"url\": \"https:\/\/drsoaraweeurology.com\/2020\/09\/04\/circumcision-reducing-hivs\/\",\n      \"name\": \"Circumcision and HIV: Why the Foreskin Matters, and What the 60\u201370% Figure Really Means\",\n      \"headline\": \"Circumcision and HIV: Why the Foreskin Matters, and What the 60\u201370% Figure Really Means\",\n      \"description\": \"Circumcision reduces female-to-male HIV transmission during vaginal sex by 60\u201370%, and three properties of the inner foreskin explain why. 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