The Effect of Medical Male Circumcision on Urogenital Mycoplasma genitalium Among Men in Kisumu, Kenya

Supriya D Mehta,Nicole Quinn,Lawrence Agunda,Charlotte Gaydos,Robert C Bailey,Stephen Moses,Elijah Odoyo-June,Ian Maclean

doi:10.1097/olq.0b013e318240189c

Abstract

We determined the prevalence of urethral Mycoplasma genitalium (MG) infection and whether infection was associated with circumcision status among men enrolled in the randomized trial of medical male circumcision to prevent HIV acquisition in Kisumu, Kenya. MG and Trichomonas vaginalis were detected in first void urine by APTIMA transcription-mediated amplification assay. first void urine and urethral swabs were assessed for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) by polymerase chain reaction assay. Herpes simplex virus type 2 antibodies were detected by IgG ELISA. Multivariable logistic regression identified factors associated with MG infection. Specimens were collected between July and September 2010, and 52 (9.9%; 95% confidence interval [CI]: 7.3%-12.4%) MG infections were detected among 526 men. N. gonorrhoeae and T. vaginalis were not associated with MG. CT coinfection was 5.8% in MG-infected men, and 0.8% among MG-uninfected men (P = 0.02). MG infection was predominantly asymptomatic (98%). The prevalence of MG was 13.4% in uncircumcised men versus 8.2% in circumcised men (P = 0.06). Being circumcised nearly halved the odds of MG (adjusted odds ratio [aQR] = 0.54; 95% CI: 0.29-0.99), adjusted for other variables significant at the P < 0.05 level: herpes simplex virus type 2 infection (aOR = 2.05; 95% CI: 1.05-4.00), CT infection (aOR = 2.69; 95% CI: 1.44-5.02), and washing the penis ≤1 hour after sex (aOR = 0.47; 95% CI: 0.24-0.95). MG infection was reduced among men who were circumcised, adding to the benefits of male circumcision in preventing several sexually transmitted infections.

Highlights

Mycoplasma genitalium is a causative pathogen in urethritis, cervicitis, pelvic inflammatory disease (PID), and tubal factor infertility [1,2,3]
Mycoplasma genitalium (MG) infection was reduced among men who were circumcised, adding to the benefits of male circumcision in preventing several sexually transmitted infections
Compared to men being followed but who were not included in the current protocol, men who underwent M. genitalium testing were more likely to be aged 26–31 than aged 23–25 (42% vs. 34%, p=0.006) and married/cohabiting (60% vs. 46%, p

Summary

Introduction

Mycoplasma genitalium is a causative pathogen in urethritis, cervicitis, pelvic inflammatory disease (PID), and tubal factor infertility [1,2,3]. Studies in western Africa found prevalences of 2% in the general population [9]; 12–18% in HIV infected or symptomatic persons [10,11]; and 26% in female sex workers [12]. In eastern Africa the prevalence of M. genitalium has been reported to be 3–5% in the general population in Tanzania [13,14], 16% in female sex works in Nairobi, Kenya [15], and 17% in HIV-positive women in Mombasa, Kenya [16]. No published studies have examined the association of male circumcision status with M. genitalium infection. We determined the prevalence of urethral Mycoplasma genitalium (MG) infection and whether infection was associated with circumcision status, among men enrolled in the randomized trial of medical male circumcision to prevent HIV acquisition in Kisumu, Kenya

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Results

Discussion

Conclusion