Study On Foreskin Development And The Relationship Between Foreskin And HIV Infection

Background:Abnormalities of external genitalia, a wide diseases spectrum of urology department, were not rare in children, which may affect the physical and mental health and normal growth of children. Recent years, external genitalia abnormalities caused much attention of parents because of the higher health consciousness and over description of media.Abnormality of foreskin was the most common and most concerned external genitalia abnormalities in children. However, the criterion in diagnosing abnormality of foreskin is still in discussing, and there is little epidemical investigation of the normal development of foreskin. Several random control trials has confirmed that circumcision could decrease the risk of HIV infection in male, and some studies on the possible mechanism were performed aboard, but up to now, there is little research about these in Chinese population. Therefore, this study performed an investigation based on a large sample, comparing the shapes of the foreskin of different ages, analyzing the distribution of children who had circumcision, providing a scientific data to make the decision of the appropriate age for circumcision. Further, by detecting the expression of HIV target cells in foreskin to explore the relationship of circumcision and HIV infection, consider the necessity of routine circumcision in order to prevent HIV infection.Purpose:To discover the natural developing process of foreskin through the investigation of foreskin shape and comparison of the age distribution of whom had circumcision, provide a scientific basis to decide the appropriate age for circumcision. By detecting the expression of HIV target cell in foreskin to explore the relationship of circumcision and HIV infection, consider the necessity of routine circumcision in order to prevent HIV infection.Methods:1. Foreskin shape of 10421 Chinese boys presented at our in-patient and out-patient department (patient in urology department not included) from 0 to 18 years old were observed. The foreskins'status were classified into five types: type I (phimosis), no retraction of foreskin at all, the urethral meatus and glans penis were invisible after foreskin retraction; type II (partial phimosis), the urethral meatus was visible only after retraction of the foreskin; type III (adhesion of prepuce), the urethral meatus and part of the glans penis were visible after retraction of the foreskin; type IV (normal),easy to expose the whole glan after retraction of the foreskin; and type V (circumcised), circumcised foreskin.2. The degree of keratinization of the inner and outer foreskin were detected by histological methods.3. The distribution of HIV-1 target cells (including Langerhans cells(CD1a), CD4 lymphocytes(CD4), macrophages(CD68)) in inner and outer foreskin was mapped by immunohistochemistry.Result:1.The phimosis rate was 99.7 % in neonate, 84.43% in infant, 48.13% in toddler, 27.12% in preschool children, 12.04% in school children, 6.81% in adolescent, respectively, in contrast, the proportion of completely retractable foreskin was 0%,0.67%,2.07%,10.72%,28.14%,46.96% in each stage. The decrease of phimosis rate was significantly associated with age increasing, r=-0.828,P<0.001.2. Preschool age was the peak age for circumcision, among who had circumcision, 55% had this surgery in preschool, 87% had circumcision before adolescent.3. Foreskin dilation was performed in 13.49% children and 30.23% of them had fully retractable foreskin in this examination, 12.58% were still phimosis. Most foreskin dilation were performed before school age, accounting for 76.81% of whom had foreskin dilation before.4. The mean thickness of keratinised epithelium of the inner foreskin was 0.45μm, the mean thickness of outer foreskin keratinised epithelium was 0.76μm in contrast, the inner foreskin was thinner than outer foreskin with statistical significant.5. CD1a was found in epithelium predominately, CD4 and CD68 were found in submucosa. More CD1a was found in the inner foreskin, there were no differences in CD4 and CD68 between inner and outer foreskin.Conclusion:Abnormal of external genitalia is not rare in children. Phimosis is common and a natural developing process in children. Most boys have their foreskins fully retracted until puberty. More HIV target cells and thinner keratinised epithelium of the inner foreskin might be the mechanism of HIV infection via sexual transmission. Decreasing of HIV target cells in foreskin may be the key point of circumcision in preventing HIV infection. However, the sexual transmission does not exist in children, performing routine circumcision to prevent HIV infection should be cautious.