text: NEW YORK (AP) — U.S. health officials on Tuesday released a draft of long-awaited federal guidelines on circumcision, saying medical evidence supports the procedure and health insurers should pay for it. 
   
   FILE - In this July 28, 2011, file photo, anti-circumcision activists Frank McGinness, right, and Jeff Brown rally against circumcision with about 25 protesters outside a San Francisco courthouse. On... (Associated Press) 
   
   The Centers for Disease Control and Prevention guidelines stop short of telling parents to have their newborn sons circumcised. That is a personal decision that may involve religious or cultural preferences, said the CDC's Dr. Jonathan Mermin. 
   
   But "the scientific evidence is clear that the benefits outweigh the risks," added Mermin, who oversees the agency's programs on HIV and other sexually transmitted diseases. 
   
   These are the first federal guidelines on circumcision, a brief medical procedure that involves cutting away the foreskin around the tip of the penis. Germs can grow underneath the foreskin, and CDC officials say the procedure can lower a male's risk of sexually-transmitted diseases, penile cancer and even urinary tract infections. 
   
   The CDC started working on the guidelines about seven years ago, when a cluster of influential studies in Africa indicated circumcision might help stop spread of the AIDS virus. 
   
   "The benefits of male circumcision have become more and more clear over the last 10 years," said Dr. Aaron Tobian, a Johns Hopkins University researcher involved in one of the African studies. 
   
   But the guidelines are important, because the rates of newborn male circumcision have been dropping, he added. 
   
   The guidelines are being published in the federal register Tuesday. For the next 45 days, the CDC will receive public comment before finalizing them next year. 
   
   They are likely to draw intense opposition from anti-circumcision advocacy groups, said Dr. Douglas Diekema, a Seattle physician who worked on a circumcision policy statement issued by the American Academy of Pediatrics in 2012. 
   
   "This is a passionate issue for them and they feel strongly that circumcision is wrong," said Diekema, a professor of pediatrics at the University of Washington. 
   
   Indeed, the head of one group did argue against the CDC's conclusions on Tuesday, saying they minimize potential complications from the procedure. 
   
   The guidelines "are part of a long historical American cultural and medical bias to attempt to defend this traumatic genital surgery," said, Ronald Goldman, executive director of the Circumcision Resource Center. 
   
   The CDC guidelines largely mirror the pediatrician group's statement, but the CDC's document incorporates more research and comes from an organization that many may see as more neutral on the topic, Diekema said. 
   
   The thinking on circumcision has swung wildly over the years. It's been practiced by Jews and Muslims for thousands of years, but didn't become common in this country until the 20th century. By one estimate, only 25 percent of U.S. male newborns were circumcised in 1900. 
   
   It gradually became the cultural norm, and in the 1950s and 1960s surpassed 80 percent. But then the trend reversed. Part of it had to do with changing demographics, as the U.S. population grew to include larger numbers of Mexican-Americans and other ethnic groups that didn't traditionally circumcise their children. 
   
   Also, opposition to the procedure grew from advocates who decried the pain, bleeding and risk of infections to newborns. Their message was aided by the Internet and by the neutral stance of physicians groups — including, for a time, the American Academy of Pediatrics. 
   
   A wave of state Medicaid programs stopped paying for newborn circumcisions, which cost roughly $150 to $200. The list eventually rose to 18 states, according to CDC numbers. 
   
   By 2010 the newborn circumcision rate was down to about 58 percent, according to one CDC estimate. 
   
   But even as the circumcision rate dropped, more medical evidence came in supporting it — particularly three rigorous and influential studies in Africa that looked at the spread of HIV and other sexually transmitted diseases in circumcised and uncircumcised men and their partners. 
   
   In the new guidelines, the CDC says there is now strong evidence that male circumcision can: 
   
   —Cut a man's risk of getting HIV from an infected female partner by 50 to 60 percent. 
   
   —Reduce their risk of genital herpes and certain strains of human papillomavirus by 30 percent or more. 
   
   —Lower the risk of urinary tract infections during infancy, and cancer of the penis in adulthood. 
   
   Studies have not shown that circumcision will reduce an HIV-infected man's chances of spreading the AIDS virus to women. And research has not found circumcision to be a help in stopping spread of HIV during gay sex. 
   
   The guidelines say circumcision is safer for newborns and infants than for older males, noting the complication rate rises from 0.5 percent in newborns to 9 percent in children ages 1 to 9, according to the CDC. Minor bleeding and pain are the most common problems, experts say. 
   
   CDC officials are recommending doctors tell parents of baby boys of the benefits and risks of circumcision. Mermin did not say how that information should be presented. 
   
   Because circumcision can be beneficial to men as well, the CDC says information about the procedure also should be given to sexually active uncircumcised men — especially men considered to be at higher risk of catching HIV, the guidelines say. ||||| The benefits of male circumcision outweigh the risks, according a long awaited draft of federal guidelines from U.S. health officials released on Tuesday, which indicate that scientific evidence supports recommending the procedure. 
   
   The U.S. Centers for Disease Control and Prevention found that medically performed male circumcision could help decrease the risk of contracting HIV and several other sexually transmitted infections (STIs) as well as other health problems. 
   
   The recommendation, which includes counseling parents of male newborns on the benefits and risks of the procedure, comes at a time when the rate of male circumcision has been decreasing in the United States. 
   
   From 1979 through 2010, the national rate of newborn circumcision declined 10 percent to 58 percent, according to the CDC. 
   
   The procedure, which has been subject of fierce debate, involves cutting the foreskin around the tip of the penis. 
   
   "These recommendations are based on an evaluation of available information on the health risks and benefits associated with high-quality, medically performed male circumcision and were developed to pertain to men and male newborns in the United States," the document said. 
   
   Several studies conducted in Africa indicated that circumcision could help reduce the spread of the virus that causes AIDS. 
   
   All uncircumcised adolescent and adult males who engage in heterosexual sex should be informed about the significant, but partial, efficacy of male circumcision in reducing the risk of acquiring HIV and some STIs through heterosexual sex, as well as the potential harms of male circumcision, the draft guidelines said. 
   
   The overall risk of adverse events associated with male circumcision is low, with minor bleeding and inflammation cited as the most common complications, according to a CDC fact sheet. 
   
   The draft recommendations are subject to a 45-day public comment period and a formal external peer review. Comments provided will be considered before recommendations are finalized, CDC said. 
   
   The agency said it developed the draft guidance based on a systematic review of all evidence on the health risks and benefits of circumcision and consultation with experts in HIV prevention and related fields. 
   
   (Reporting by Bill Berkrot in New York; Editing by Lisa Shumaker) ||||| The Centers for Disease Control and Prevention has released proposed guidance on circumcision that says the surgical procedure would help straight men in the United States reduce their risk of becoming infected with HIV, the virus that causes AIDS. 
   
   “Given the urgency of the HIV epidemic in the United States, CDC believes it is essential to maximize the impact of all available prevention options,” the CDC said in the guidelines. “Male circumcision is one strategy that may help reduce the continued spread of HIV in the U.S.” 
   
   The draft guidance, published Tuesday in the Federal Register, states that all uncircumcised, sexually active straight males and adolescents — as well as parents of newborn males — should be counseled by their doctors on the key risks and benefits of circumcision. 
   
   The guidelines also emphasize that “male circumcision is a voluntary procedure” and that decisions about circumcision should take “personal, cultural, religious and ethical beliefs” into account. 
   
   Clinical trials and observational studies have found that men who are circumcised are less likely than their uncircumcised peers to acquire sexually transmitted infections during vaginal sex. Being circumcised reduced the risk of infection with HIV from a female sexual partner by 50% to 60%. It also reduced the risk of getting genital herpes by up to 45% and of getting cancer-causing strains of human papillomavirus by 30%. 
   
   However, circumcision did not reduce the risk of getting HIV or other infections during anal sex with other men. 
   
   Studies have also found that sex with circumcised men is safer for women. They are less likely to become infected with HPV, bacterial vaginosis and trichomoniasis, the CDC guidelines state. There is no medical evidence linking male circumcision to reduced risk of HIV for female partners, the guidelines note. 
   
   The CDC states that the risk of adverse events from circumcision is low, and that minor bleeding and inflammation are the biggest problems. The agency says complications arise in less than one-half of 1% of newborns, 9% of children and about 5% of adults. 
   
   “Severe complications can occur but are exceedingly rare,” the CDC wrote. 
   
   In making the case that the health benefits of circumcision outweigh the risks, the federal agency tacitly endorsed the position of the American Academy of Pediatrics. 
   
   “Although health benefits are not great enough to recommend routine circumcision for all male newborns, the benefits of circumcision are sufficient to justify access to this procedure for families choosing it and to warrant third-party payment for circumcision of male newborns,” the pediatrician group said in a policy statement issued in 2012. 
   
   About 58% of newborn boys in the U.S. are circumcised before they leave the hospital, according to the CDC. 
   
   Release of the draft recommendation kicked off a 45-day public comment period, and opponents of the controversial practice vowed to make their voices heard. 
   
   Among a number of concerns, opponents of circumcision, or “intactivists,” say it’s wrong to perform permanent elective surgery on a newborn. That decision can only be made by a consenting adult, they say. 
   
   “If someone feels they need to cut off the best part of their penis when they’re 18 ... the choice should be up to the person who’s being subjected to the surgery,” said Lloyd Schofield, who once petitioned to have the procedure banned in San Francisco. “That’s the crux of our message.” 
   
   Dr. Thomas Newman, a professor of epidemiology and biostatistics at UC San Francisco, says he believes that the medical benefits of circumcision outweigh the risks but that both are small. 
   
   Wondering whether a significant number of men who were circumcised as newborns are unhappy with their parents’ decision, Newman said: “Some certainly are quite distressed about their neonatal circumcisions.” 
   
   The CDC noted in its guidelines that circumcision is “simpler, safer and less expensive” for infants than it is for adults. Yet it also wrote that “delaying circumcision until adolescence or adulthood enables the male to participate in — or make — the decision.” 
   
   “Adult men who undergo circumcision generally report minimal or no change in sexual satisfaction or function,” the agency added. 
   
   While the draft statement focused on circumcision’s benefits in fighting HIV and sexually transmitted infections, AIDS activists expressed doubt that it would make much difference here. 
   
   “Since the epidemic in the United States is being driven primarily by men who have sex with men, we’re not sure if it’s relevant for gay men in this country,” said Vallerie Wagner, director of health and wellness programs at AIDS Project Los Angeles. 
   
   Twitter: @montemorin
target: – To snip or not to snip? Male circumcision carries "low" risks but has "dramatic" benefits, according to draft guidelines released by the CDC yesterday. The long-awaited guidelines say that the procedure can greatly reduce the risk of HIV and other sexually transmitted diseases for heterosexual men, reports Reuters, which notes that circumcision rates have dropped 10% to 58% over the last three decades. Circumcision is a personal decision, and the guidelines will stop short of recommending all newborn boys undergo the procedure, but "the scientific evidence is clear that the benefits outweigh the risks," a CDC spokesman tells the AP. The CDC says that circumcision can reduce the risk of a man getting HIV or herpes from a female partner by around 50%. It also makes sex safer for female partners, although it doesn't appear to reduce the risk of contracting STDs during anal sex with other men. The draft guidelines—which will face stiff opposition from anti-circumcision groups—say the risk of complications from circumcision is only 0.5% for newborns, reports the Los Angeles Times. That rises to 9% among children, then drops to 5% among adults, though the guidelines—which say circumcised men "generally report minimal or no change in sexual satisfaction or function"—note that waiting for a boy to reach adolescence or adulthood lets him choose for himself. (California has banned attempts to ban circumcision.)