Neil Canavan

July 12, 2013

KUALA LUMPUR, Malaysia — A novel device called the Shang Ring that is used to perform male circumcision has been shown to be safe and relatively pain-free in a field trial of more than 1000 men in Kenya and Zambia.

A Shang Ring circumcision takes a fraction of the time of conventional surgical methods and requires minimal training, so even lower-level healthcare providers can use it.

"Male circumcision is one of the most promising improvements for reducing HIV infection in sub-Saharan Africa," said Mark Barone, DVM, MS, from EngenderHealth in New York. "Unfortunately, even though we know that circumcision reduces the incidence of men acquiring HIV, the procedure itself is a barrier to realizing this benefit."

Conventional circumcision can take 20 to 40 minutes to perform, suturing is required, "and usually there is a fair amount of bleeding. Using the Shang Ring reduces the procedure time to 5 to 7 minutes, requires no suturing, and there is almost no bleeding," he explained.

Dr. Barone presented data on the safety and efficacy of the Shang Ring here at the 7th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention.

Investigators studied the device in 1161 men at 10 sites in Africa and followed patients for up to 42 days after undergoing a circumcision.

Rates of postcircumcision procedure-related adverse events were low (1.6%); however, 2 men had to have the device removed before the day 7 visit because of pain.

Male circumcision is one of the most promising improvements for reducing HIV infection in sub-Saharan Africa.

Time to complete healing was 35 to 42 days, as was expected. Overall, 21.3% of the men reported returning to normal activities on the day of circumcision, and 95.0% reported doing so by the third day.

"The vast majority of the men really liked the procedure," Dr. Barone noted. They liked the cosmetic appearance of their penis, and most said they would recommend the ring procedure to others."

Nonphysicians performed 97.0% of the procedures, and 70.5% of the circumcisions were conducted at sites without previous Shang Ring experience.

Of the 19 providers involved in the study, 17 preferred the Shang Ring to conventional surgery.

The simplicity and low cost of this method will reportedly facilitate the male circumcision initiatives that are part of HIV prevention strategies in developing countries.

"It's vital to have additional options for male circumcision to help increase the impact of this approach," said Dr. Barone. "We need to align our resources so that men who are interested in being circumcised have access."

Ugandan Experience With the Shang Ring

Godfrey Kigozi, MBChB, MPH, from the Rakai Health Sciences Program in Kalisizo, Uganda, has also had experience with the Shang Ring.

"We did a program recently on about 500 men and compared the ring with the dorsal slit method," Dr. Kigozi told Medscape Medical News. "We saw a few more postoperative problems with the ring — just a few — and wound healing took a bit longer. We did have an issue of some of the men in our study resuming intercourse before complete healing had occurred. It does take a month to heal."

The procedure itself is, however, much faster. "It was roughly 6 minutes, as opposed to nearly 20 to perform the dorsal slit."

"I found it to be very good for the rural setting. Backup surgical services might be needed for men who have certain anatomic characteristics, but overall, I think a bit more training would eliminate most adverse events."

Dr. Barone and Dr. Kigozi have disclosed no relevant financial relationships.

7th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention: Abstract WELBC042. Presented July 3, 2013.


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