In reply
Although randomized trials can most effectively demonstrate the efficacy of male circumcision on the incidence of sexually transmitted infections (STIs), in our review of the data, we provided an overview of the literature including relevant observational studies on the impact of circumcision on STIs (both positive and negative).1 We included 13 studies that do not support an association between male circumcision and reduced STIs, 6 references that evaluated the risks of male circumcision, and 2 articles that discussed ethical considerations. Our table also listed 4 bacterial STIs that are not reduced by male circumcision. However, we did not include studies whose validity has been substantially questioned owing to selective use of secondary information.2-4