Background:
Male circumcision (MC) provides highly effective protection against acquisition of HIV infection in heterosexual men. There are few studies of the epidemiology of MC in men in the United States. Differences in the frequency of MC over time or by group could help target educational and policy efforts. Clinicians at the San Francisco municipal STD clinic examine each male patient for the presence of penile circumcision.

Objective:
Describe trends in the epidemiology of MC in STD clinic patients San Francisco

Method:
We reviewed electronic medical records from 1996-2005. We determined MC status by sexual orientation, race/ ethnicity, age, and HIV status. We compared proportions by the Chi-square test for significance

Result:
96,339 (71%) of 136,679 males were circumcised. In straight men, 67% were circumcised versus 74% of gay men (P<.01). By race/ethnicity: 62% of Asian, 79% of African-American, 58% of Hispanic, 65% of Native American, 68% of Pacific Islander and 74% of White were circumcised (P<.01) . Of men age 15-19 years 60% were circumcised versus 62% of men age greater than 55 years (P>.05). There were no significant trends by age within racial/ethnic groups. In gay men there was no association of HIV-status by MC status (uncircumcised 33.1% HIV(+) vs. circumcised 34.0% HIV (+), P >.05).

Conclusion:
Many male STD patients were circumcised; African-American men were circumcised most often. MC rates over time have been stable with no temporal changes within racial/ethnic groups. The lack of association of MC in gay men and HIV infection was not surprising given that most gay men acquire HIV through receptive anal intercourse.

Implications:
The high and stable rate of MC suggests that in the light of its proven efficacy to prevent HIV infection in heterosexual men, continued acceptance of MC should be feasible.