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The circumcision conundrum

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Science  11 Jul 2014:
Vol. 345, Issue 6193, pp. 161
DOI: 10.1126/science.345.6193.161

No clear mechanism explains how removing a foreskin protects men from HIV, but traditional penile cutting in Papua New Guinea may help clarify.

Stuart Turville had a surprising item to declare last September when he arrived here from Papua New Guinea (PNG) on a Friday evening flight: a cooler that contained five freshly harvested foreskins packed on ice. “Coming in with samples like this is always somewhat amusing to customs officials in Australia,” says Turville, a virologist at the Kirby Institute for Infection and Immunity in Society in Sydney.

Turville's team regularly imports this precious cargo from its neighbor to answer a fundamental but underexplored question: How does male circumcision protect against HIV?

Studies have clearly shown that medical circumcision works, but confusion remains about the mechanism. Foreskins surgically removed from men in PNG who opt to go through medical circumcision offer an intriguing opportunity to address the question. Whereas some had fully intact foreskins, many had various traditional penile cuts as boys (see main story).

PHOTO: THOMAS HOPE, NORTHWESTERN UNIVERSITY'S FEINBERG SCHOOL OF MEDICINE

Turville is leading lab studies that incubate these different foreskins with fluorescently labeled HIV (pictured). That allows researchers to assess how the transmission process is affected by factors that vary among the foreskins, including the degree of keratinization (in red) and the presence of immune target cells.

Surprisingly few groups have published studies about the protective mechanism of circumcision, says virologist Thomas Hope of Northwestern University's Feinberg School of Medicine in Chicago, Illinois, a veteran researcher of foreskins and HIV who has begun collaborating with the Kirby Institute group. “And a lot of it is wrong.”

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