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

The PrePex circumcision device causes ischemie 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. Pre-Pex 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 × 10⁷ 16S rRNA gene copies/swab in the PrePex group and 1.1 × 10⁶ 16S rRNA gene copies/swab in uncircumcised men; P = .002), Peptoniphilus (1.0 × 10⁷ and 1.8 × 10⁶ 16S rRNA gene copies/swab, respectively; P < .05), Anaerococcus (1.0 × 10⁷ and 1.1 × 10⁶ 16S rRNA gene copies/swab, respectively; P< .001), and Campylobacter ureolyticus (1.7 × 10⁵ and 1.6 × 10⁷ 16S rRNA gene copies/swab, respectively; P