title: Genital Anaerobic Bacterial Overgrowth and the PrePex Male Circumcision Device, Rakai, Uganda.
abstract: The PrePex circumcision device causes ischemic necrosis of the foreskin, raising concerns of anaerobic overgrowth. We compared the subpreputial microbiome of 2 men 7 days after PrePex device placement to that of 145 uncircumcised men in Rakai, Uganda, using 16S ribosomal (rRNA) RNA gene-based quantitative polymerase chain reaction analysis and sequencing. PrePex users had higher absolute abundance of all bacteria than uncircumcised men (P = .001), largely due to increased numbers of the following anaerobes: Porphyromonas (5.2 × 10(7) 16S rRNA gene copies/swab in the PrePex group and 1.1 × 10(6) 16S rRNA gene copies/swab in uncircumcised men; P = .002), Peptoniphilus (1.0 × 10(7) and 1.8 × 10(6) 16S rRNA gene copies/swab, respectively; P < .05), Anaerococcus (1.0 × 10(7) and 1.1 × 10(6) 16S rRNA gene copies/swab, respectively; P < .001), and Campylobacter ureolyticus (1.7 × 10(5) and 1.6 × 10(7)16S rRNA gene copies/swab, respectively; P < .001). The PrePex-associated increase in anaerobes may account for unpleasant odor and a possible heightened risk of tetanus.
authors.affiliation: Department of Pathology, School of Medicine Center for Microbial Genetics and Genomics, Northern Arizona University Division of Pathogen Genomics, Translational Genomics Research Institute, Flagstaff, Arizona.
authors.forename: Cindy M
authors.initials: CM
authors.lastname: Liu
authors.affiliation: Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Prodger
authors.affiliation: Department of Pathology, School of Medicine Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland Rakai Health Sciences Program, Entebbe, Uganda.
authors.forename: Aaron A R
authors.initials: AA
authors.lastname: Tobian
authors.affiliation: Rakai Health Sciences Program, Entebbe, Uganda.
authors.forename: David
authors.initials: D
authors.lastname: Serwadda
authors.affiliation: Rakai Health Sciences Program, Entebbe, Uganda.
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Galiwango
authors.affiliation: Rakai Health Sciences Program, Entebbe, Uganda.
authors.forename: Fred
authors.initials: F
authors.lastname: Nalugoda
authors.affiliation: Rakai Health Sciences Program, Entebbe, Uganda.
authors.forename: Nehemiah
authors.initials: N
authors.lastname: Kighoma
authors.affiliation: Rakai Health Sciences Program, Entebbe, Uganda.
authors.forename: Joshua
authors.initials: J
authors.lastname: Mwinike
authors.affiliation: Rakai Health Sciences Program, Entebbe, Uganda.
authors.forename: Margaret
authors.initials: M
authors.lastname: Anyokorit
authors.affiliation: Division of Pathogen Genomics, Translational Genomics Research Institute, Flagstaff, Arizona Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University.
authors.forename: Lance B
authors.initials: LB
authors.lastname: Price
authors.affiliation: Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland Rakai Health Sciences Program, Entebbe, Uganda.
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Wawer
authors.affiliation: Rakai Health Sciences Program, Entebbe, Uganda.
authors.forename: Godfrey
authors.initials: G
authors.lastname: Kigozi
authors.affiliation: Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland Rakai Health Sciences Program, Entebbe, Uganda.
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Gray
mesh_terms: D000293:Adolescent; D000328:Adult; D001421:Bacteria, Anaerobic / Q000145:classification* / Q000302:isolation & purification*; D058491:Bacterial Load; D002944:Circumcision, Male / Q000009:adverse effects*; D004269:DNA, Bacterial / Q000737:chemistry / Q000235:genetics; D004275:DNA, Ribosomal / Q000737:chemistry / Q000235:genetics; D004864:Equipment and Supplies; D006801:Humans; D008297:Male; D064307:Microbiota; D010413:Penis / Q000382:microbiology*; D012336:RNA, Ribosomal, 16S / Q000235:genetics; D060888:Real-Time Polymerase Chain Reaction; D017422:Sequence Analysis, DNA; D014454:Uganda; D055815:Young Adult
chemical_list: D004269:DNA, Bacterial; D004275:DNA, Ribosomal; D012336:RNA, Ribosomal, 16S
keywords: PrePex device; Uganda; anaerobes; male circumcision; penile microbiota; tetanus