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Bacterial Vaginosis–Associated Bacteria in Men: Association of Leptotrichia/Sneathia spp. With Nongonococcal Urethritis

Manhart, Lisa E. PhD*; Khosropour, Christine M. MPH*; Liu, Congzhu MS; Gillespie, Catherine W. PhD; Depner, Kevin BS, BA; Fiedler, Tina BS; Marrazzo, Jeanne M. MD, MPH§; Fredricks, David N. MD†§

doi: 10.1097/OLQ.0000000000000054
Original Study

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.

Leptotrichia/Sneathia spp. was significantly associated with urethritis (nongonococcal urethritis). Bacterial vaginosis–associated bacteria 2 and 3 and Megasphaera were infrequently detected but almost exclusively in nongonococcal urethritis cases. Doxycycline was more effective than azithromycin for clinical cure.

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

This work was supported by the National Institutes of Health/National Institute of Allergy and Infectious Diseases (R21 AI1091970, U19 AI31448, and R01 AI072728).

Conflict of interest: None declared.

Correspondence: Lisa E. Manhart, PhD, UW Center for AIDS and STD, 325 9th Ave, Seattle, WA 98104. E-mail:

Received for publication August 16, 2013, and accepted September 29, 2013.

© Copyright 2013 American Sexually Transmitted Diseases Association