Adverse Events after Voluntary Medical Male Circumcision in Swaziland

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Alison M. Bales, BA
David J. Dennis, BS
Ronald J. Markert, PhD
Mary C. McCarthy, MD, FACS
Robert C. Siska, BS
Michael A. Schneider, BS
Echo VanderWal, PA
Harry VanderWal, MD


Background: The Luke Commission (TLC) provides comprehensive mobile healthcare in rural Swaziland, a country with a 26% prevalence of HIV. Voluntary medical male circumcision (VMMC) has been shown to reduce the rate of HIV transmission by 60%. Initial national guidelines have recommended circumcision for infants and HIV-negative men ages 15-24 but have not included recommendations for boys ages 60 days-ten years old. is study evaluated the safety of circumcision in younger boys and those with HIV.

Methods: Forceps-guided circumcision was performed under local block in 1,500 male patients. Incidence of adverse events (AEs)--infection, bleeding and dehiscence - was examined as a function of age, weight, HIV status and season.

Results: The AE rate was 2.1% (31/1500); boys age ≤ 12 had 2.0% (20/1022) compared to 2.3% (11/478 ) in patients age ≥ 13 (p=0.66). Patients ≤ 29kg had 2.4% (16/662) AE compared to 1.8% (15/838) in patients >30kg (p=0.40). HIV-positive patients had 0% (0/76) AE. 2.9% (10/343) of patients who underwent circumcision during the summer incurred wound dehiscences, compared to 1.6% (10/640) in the fall and 0% (0/517) in the winter [p=0.001].

Conclusions: The novel use of double povidone-iodine prep with close follow-up produced adverse event rates comparable to those reported in the literature, even in rural settings. Circumcising younger patients or HIV-positive males did not result in higher adverse event rates.

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Original Research
How to Cite
Bales, A. M., Dennis, D. J., Markert, R. J., McCarthy, M. C., Siska, R. C., Schneider, M. A., VanderWal, E., & VanderWal, H. (2016). Adverse Events after Voluntary Medical Male Circumcision in Swaziland. The Columbia University Journal of Global Health, 6(2), 27–30.