Case series of glans injuries during voluntary medical male circumcision for HIV prevention — eastern and southern Africa, 2015–2018

Table 1 Rate of glans injuries per 100,000 VMMCs performed in patients less than 15 years old

Year	Any glans injury			Glans injury related to FG
Year	Number of injuries	Number of circumcisions age 0–14	Number of injuries per 100,000 circumcisions (95% CI)^b	Number of injuries	Number of circumcisions age 10–14	Number of injuries per 100,000 circumcisions (95% CI)^c
2015^a	8	1,099,859	0.73 (0.31–1.43)	7	1,060,878	0.66 (0.26–1.36)
2016	7	963,067	0.73 (0.29–1.50)	7	953,357	0.73 (0.30–1.51)
2017	11	1,572,079	0.70 (0.35–1.25)	8	1,560,375	0.51 (0.22–1.01)
2018	7	1,689,178	0.41 (0.17–0.85)	4	1,672,993	0.24 (0.07–0.61)
Overall	33	5,324,183	0.62 (0.43–0.87)	26	5,247,603	0.50 (0.32–073)

In July 2014, WHO announced the risk of glans injury with FG method in males 10–14 years. PEPFAR followed shortly thereafter disallowing FG use in this age group. Data on glans injury rate prior to 2015 is not available
3 glans injuries reported retrospectively from 2014 were excluded
The number of PEPFAR notifiable AEs, which include death, glans injuries, tetanus, any AE resulting in permanent deformity or disability, and any AE requiring hospital admission for 3 days or more reported each year increased during this time period. This is suspected to correspond with improved reporting capacity to PEPFAR within countries implementing VMMC. However, although reporting to PEPFAR is mandatory, ascertainment of NAERS is not known
^a2015 includes an extra quarter of VMMCs in the denominator, corresponding to Oct-Dec 2014 (i.e., FY2015Q1). This data was not disaggregated at the time. Thus, the actual rate for 2015 is slightly higher than shown, although unknown to what degree
^bP-value = 0.02 for testing a trend in rates across years
^cP-value < 0.01 for testing a trend in rates across years
FG forceps-guided method; CI confidence interval

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