No Difference in Keratin Thickness between Inner and Outer Foreskins from Elective Male Circumcisions in Rakai, Uganda
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Date
2012
Journal Title
Journal ISSN
Volume Title
Publisher
PLoS ONE
Abstract
It has been hypothesized that increased HIV acquisition in uncircumcised men may relate to a more thinly keratinized
inner foreskin. However, published data are contradictory and potentially confounded by medical indications for
circumcision. We tested the hypothesis that the inner foreskin was more thinly keratinized than the outer foreskin using
tissues from 19 healthy, HIV-uninfected men undergoing routine prophylactic circumcision in Rakai, Uganda. Sections
from 3 foreskin anatomic sites (inner, outer, and frenar band) were snap-frozen separately. Two independent
laboratories each separately stained, imaged, and measured keratin thicknesses in a blinded fashion. There was no
significant difference in keratin thickness between the inner (mean = 14.6767.48 mm) and outer (mean = 13.3068.49 mm)
foreskin, or between the inner foreskin and the frenar band (mean = 16.91612.42 mm). While the frenar band showed
the greatest intra-individual heterogeneity in keratin thickness, there was substantial inter-individual variation seen in all
regions. Measurements made by the two laboratories showed high correlation (r = 0.741, 95% CI, 0.533–0.864). We
conclude that, despite inter- and intra-individual variability, keratin thickness was similar in the inner and outer foreskin
of healthy Ugandan men, and that reduced keratin thickness is not likely to make the inner foreskin more susceptible
to HIV acquisition.
Description
Keywords
Keratin Thickness, Inner and Outer Foreskins, Elective Male Circumcisions, Uganda
Citation
Dinh MH, Hirbod T, Kigozi G, Okocha EA, Cianci GC, et al. (2012) No Difference in Keratin Thickness between Inner and Outer Foreskins from Elective Male Circumcisions in Rakai, Uganda. PLoS ONE 7(7): e41271. doi:10.1371/journal.pone.0041271