Infectious Complications of Circumcision and Their Prevention

Context: A growing body of evidence supports the health benefits of circumcision, but the occurrence of infectious complications is of concern. Objective: To review literature presenting past data and studies of infectious complications of circumcision and their prevention. Evidence acquisition: A literature search was conducted of the Cochrane Library, Embase, Turning Research into Practice, PubMed, and Medline databases from their inception through June 25, 2015. Results were closely evaluated, and articles and documents that were not pertinent or redundant were excluded. Evidence synthesis: Although uncommon, local, systemic, and toxin-related infectious complications of circumcision represent a significant clinical problem. In general, untrained providers create more infectious and noninfectious complications when performing male circumcision than do well-trained providers, regardless of whether they are physicians, nurses, or traditional religious providers. Local complications include staphylococcal and streptococcal infections, cellulitis, impetigo, pyoderma, necrotizing fasciitis, scalded skin syndrome (staphylococcal), Fournier gangrene, glanular necrosis, scrotal abscess, and peritonitis. Ritual circumcision is rarely associated with acquisition of tuberculosis, diphtheria, or herpes virus. Systemic infectious complications include bacteremia, wound sepsis, and meningitis. Circumcision has also been associated with neonatal and adult tetanus. Conclusions: Infectious complications following circumcision should be reduced with trained and competent practitioners performing the procedure using sterile techniques. Patient summary: Complications of circumcision represent a significant problem. Male circumcision should be performed by trained, competent practitioners using sterile techniques and effective pain management. (C) 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.