Genital Anaerobic Bacterial Overgrowth and the PrePex Male Circumcision Device, Rakai, Uganda

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 x 10(7) 16S rRNA gene copies/swab in the PrePex group and 1.1 x 106 16S rRNA gene copies/swab in uncircumcised men; P = .002), Peptoniphilus (1.0 x 10(7) and 1.8 x 10(6) 16S rRNA gene copies/swab, respectively; P < .05), Anaerococcus (1.0 x 10(7) and 1.1 x 10(6) 16S rRNA gene copies/swab, respectively; P < .001), and Campylobacter ureolyticus (1.7 x 10(5) and 1.6 x 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.