BACKGROUND: Randomized control trials in sub-Saharan countries found male circumcision may prevent high-risk human papillomavirus (HR-HPV) acquisition. Using 2013-2016 National Health and Nutrition Examination Survey data, we explored the association between circumcision and HR-HPV among sexually experienced 18-59-year-old males. METHODS: Self-collected penile specimens were tested for HPV DNA. We estimated weighted HR-HPV prevalence (positivity to ≥1 HR type: HPV16/18/31/33/35/39/45/51/52/56/58/59/66/68) by circumcision status. The association between circumcision and HR-HPV was assessed using multivariable logistic regression models. Effect modification by circumcision on the association between number of lifetime sex partners and HR-HPV was explored. RESULTS: Overall, 77.7% of males reported being circumcised, with large variation by race/ethnicity and country of birth. HR-HPV prevalence was significantly higher among circumcised (25.7%) than uncircumcised (20.4%) males; this was attenuated after adjustment for lifetime and new past-year sex partners (adjusted prevalence ratio: 1.10, 95%CI: 0.92-1.32). There was evidence circumcision modified the association between lifetime partners and HR-HPV, but HR-HPV prevalence increased with increasing number of partners in circumcised and uncircumcised males. CONCLUSIONS: Our observed lack of statistical association between circumcision and HR-HPV may differ from randomized trial results due to the differences between circumcised and uncircumcised males or differences in anatomic site sampled or timing of circumcision.

The Advisory Committee on Immunization Practices recommends routine human papillomavirus (HPV) vaccination at 11-12 years; the series can begin at age 9. U.S. HPV vaccination coverage is lower than other adolescent vaccinations. One proposed strategy to increase coverage is initiation at 9-10 years. We systematically reviewed studies addressing vaccination at age 9 to identify and evaluate evidence regarding potential programmatic advantages. Among 30 publications from 2014 to 2024 there were retrospective cohort studies (N = 11), intervention studies with a component focused on vaccination at 9-10 (N = 12), and studies of feasibility or acceptability by providers or caregivers (N = 7). While retrospective analyses found earlier initiation associated with completion, limitations in methodology preclude a cause-and-effect interpretation. Impact of age 9 vaccination is difficult to isolate in intervention studies that had multiple components. While initiating vaccination at age 9 is feasible, questions remain regarding the benefit of this approach to increase coverage.