A newly released report from Johns Hopkins University says a steady decline in rates of U.S. infant male circumcision could add more than $4.4 billion in avoidable health care costs if rates continue to decline over the next decade. Additionally, Johns Hopkins says the 20-year decline in the number of males circumcised at birth has already cost the nation over $2 billion.

In a study published in the Archives of Pediatrics & Adolescent Medicine online publication, Johns Hopkins researchers have found that, due to the added expense stemming from higher rates of sexually transmitted infections and related cancers among uncircumcised men and their female partners, the cost of uncircumcised male infants could add billions to health care costs.

Experts at Johns Hopkins say the removal of the foreskin discourages the buildup of bacteria and viruses in the folds of the penis, putting circumcised males at lower risk for those infections—citing HIV/AIDS, herpes, and genital warts, as well as cervical and penile cancers as more common in uncircumcised males and their partners. Johns Hopkins says the study is the first cost analysis to account for increased rates of multiple infectious diseases associated with lower rates of male circumcision; previous research has focused only on the most costly infections, such as HIV.

Health epidemiologist and pathologist, Aaron Tobian, M.D., Ph.D, and senior study investigator says the United States has experienced a significant decline in male circumcision, starting at 79 percent in the 1970’s and 80’s to the current rate of 55 percent. Johns Hopkins says the rates in Europe are as low as 10 percent, while in Denmark only 1.6 percent of all infant males are circumcised.

Dr. Tobian, assistant professor at the Johns Hopkins University School of Medicine says, “Our economic evidence is backing up what our medical evidence has already shown to be perfectly clear.” Johns Hopkins says if rates in the United States drop to the same levels as Europe, the cost could skyrocket. “There are health benefits to male circumcision in guarding against illness and disease, and declining male circumcision rates come at a severe price, not just in human suffering, but in billions of heatlh care dollars as well.”

Dr. Tobian and his team found that, if U.S. male circumcision rates continue to drop to European levels, the population could expect to see 4,843 new cases of HIV infection, 57,124 new cases of human papillomavirus (HPV), 124,767 new cases of herpes simplex virus, and 26, 876 new cases of infant male urinary tract infections—a 211 percent increase. The study also found that there would be a 50 percent increase in bacterial vaginosis and trichomoniasis—538, 865 and 64, 585 new cases, respectively— among female partners.

Dr. Tobian says the decrease in infant male circumcision is due to funding cuts in government assistance, such as Medicaid, citing 18 states as having cut funding for the procedure. Dr. Tobian says, “The financial and health consequences of these decisions are becoming worse over time, especially if more states continue on this ill-fated path.” Dr. Tobian adds, “State governments need to start recognizing the medical benefits as well as the cast savings from providing insurance coverage for infant male circumcision.”