AIDS News Worldwide
Shang Ring for Circumcision Is Safe If Left on for More Than 7 Days
Author: Mark Mascolini
10 July 2012
A nonsurgical device for male circumcision, the Shang Ring, usually
detaches itself safely if left in place for more than the recommended
7 days, according to results of a 50-man study in Kenya. The ring
proved effective and acceptable, as in earlier studies.
Three randomized trials found that circumcision lowered the risk of
HIV acquisition about 60% in heterosexual African men.
“The Shang Ring consists of two concentric plastic rings that lock
together over the foreskin, and is then removed and disposed of 7 days
later,” PR Newswire reports. Surgical circumcision takes 20 to 40
minutes in a single visit, but it requires more training than Shang
Ring placement and it can cause bleeding and other complications.
The Shang Ring should be removed after 7 days, but some men may not be
able to return to clinic for removal in 7 days. To see if longer Shang
Ring placement causes problems, researchers randomly assigned 50
HIV-negative men to device removal at 7 days (15 men), 14 days (15
men), or 21 days (20 men).
Circumcision was successful in all men, and the device was removed
without significant problems. Time for circumcision to occur averaged
6.5 days (standard deviation 2.4), and time for device removal
averaged 2.5 minutes (standard deviation 0.8).
Among men who wore the Shang Ring for more than 7 days, complete
detachment occurred in 22 (66.7%). Seven men (14%) in whom the ring
partially detached requested removal 8 to 14 days after circumcision
because of pain or discomfort.
Healing progressed normally in all men, and cumulative probability of
complete healing was similar in the three groups. Removal time had
little effect on wound healing. There were no severe or serious
adverse events in any men, and acceptability was high in all men.
Providers rated Shang Ring circumcision “very easy” compared with the
The researchers believe these findings should “help allay concerns
about men not returning for ring removal and expand the evidence base
suggesting the Shang Ring could facilitate rapid male circumcision
rollout in sub-Saharan Africa.”
Mark A. Barone, Quentin D. Awori, Philip S. Li, Raymond O. Simba, Mark
A. Weaver, Jairus O. Okech, Alex O. Aduda, Peter Cherutich, Nicholas
Muraguri, John Masasabi Wekesa, Jared Nyanchoka, Paul Perchal, Puneet
Masson, Richard Lee, Marc Goldstein, Jackson Kioko, Ojwang' Lusi,
David C. Sokal. Randomized trial of the Shang ring for adult male
circumcision with removal at one to three weeks: delayed removal leads
to detachment. JAIDS. 2012; 60: e82-e89.
PRNewswire. Study affirms safety and acceptability of Shang ring for
reducing HIV risk among men. 28 June 2012.
For the study abstract
(Downloading the complete article requires a subscription to JAIDS or
an online payment; the abstract is free.)
For the PRNewswire article
For a YouTube video on the Shang Ring