Bacterial vaginosis-associated bacteria in men: association of Leptotrichia/Sneathia spp. with nongonococcal urethritis.
BACKGROUND
Approximately 45% of nongonococcal urethritis cases have no identified etiology. Novel bacteria recently associated with bacterial vaginosis (BV) in women may be involved. We evaluated the association of idiopathic nongonococcal urethritis and 5 newly described BV-associated bacteria (BVAB).


METHODS
Heterosexual men 16 years or older attending a sexually transmitted disease clinic in Seattle, Washington, from May 2007 to July 2011 and negative for Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Mycoplasma genitalium, and Ureaplasma urealyticum-biovar2 were eligible. Cases had urethral discharge or 5 or more polymorphonuclear leukocytes per high-power field in urethral exudates. Controls had no urethral discharge and less than 5 polymorphonuclear leukocytes per high-power field. Urine was tested for Atopobium spp., BVAB-2, BVAB-3, Megasphaera spp., and Leptotrichia/Sneathia spp. using quantitative taxon-directed polymerase chain reaction.


RESULTS
Cases (n = 157) and controls (n = 102) were of similar age, education, and income, and most were white. Leptotrichia/Sneathia spp. was significantly associated with urethritis (24/157 [15.3%] vs. 6/102 [5.9%], P = 0.03). BVAB-2 was more common in cases than in controls (7/157 [4.5%] vs. 1/102 [1.0%], P = 0.15), and BVAB-3 (n = 2) and Megasphaera spp. (n = 1) were only detected in men with urethritis, but these bacteria were found only in men who also had Leptotrichia/Sneathia spp. Atopobium spp. was not associated with urethritis. The quantity of bacteria did not differ between cases and controls. Among treated cases, doxycycline was more effective than azithromycin for clinical cure of men with Leptotrichia/Sneathia spp. (9/10 vs. 7/12, P = 0.16) and BVAB-2 (3/3 vs. 0/3, P = 0.10).


CONCLUSIONS
Leptotrichia/Sneathia spp. may be urethral pathogens or contribute to a pathogenic microbiota that can also include BVAB-2, BVAB-3, and Megasphaera spp. Doxycycline may be more effective than azithromycin against these newly identified bacteria.
From the *Department of Epidemiology, University of Washington, Seattle WA; †The Fred Hutchinson Cancer Research Center, Seattle, WA; ‡Children's National Medical Center, Washington, DC; and §Department of Medicine, University of Washington, Seattle, WA.
Lisa E
LE
Manhart
Christine M
CM
Khosropour
Congzhu
C
Liu
Catherine W
CW
Gillespie
Kevin
K
Depner
Tina
T
Fiedler
Jeanne M
JM
Marrazzo
David N
DN
Fredricks
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004197:Disease Reservoirs / Q000382:microbiology; D004318:Doxycycline / Q000627:therapeutic use; D005260:Female; D045825:Fusobacteriaceae Infections / Q000382:microbiology* / Q000635:transmission; D016905:Gram-Negative Bacterial Infections / Q000382:microbiology* / Q000635:transmission; D020010:Heterosexuality; D006801:Humans; D045183:Leptotrichia / Q000472:pathogenicity*; D008297:Male; D045851:Megasphaera / Q000472:pathogenicity*; D012725:Sexual Behavior; D012747:Sexual Partners; D012959:Socioeconomic Factors; D014526:Urethritis / Q000209:etiology / Q000382:microbiology*; D016585:Vaginosis, Bacterial / Q000382:microbiology* / Q000635:transmission
D000900:Anti-Bacterial Agents; D004318:Doxycycline