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

Background: 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. Methods: M. genitalium and Trichomonas vaginalis (TV) were detected in first void urine (FVU) by APTIMA transcription mediated amplification assay. FVU and urethral swabs were assessed for N. gonorrhoeae (NG) and C. trachomatis (CT) by polymerase chain reaction assay. HSV-2 antibodies were detected by IgG ELISA. Multivariable logistic regression identified factors associated with MG infection. Results: Specimens were collected between July and September 2010, and 52 [9.9%; 95% CI: 7.3-12.4%] MG infections were detected among 526 men. NG and TV were not associated with MG. CT co-infection 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 vs. 8.2% in circumcised men (p=0.06). Being circumcised nearly halved the odds of MG [adjusted OR=0.54; 95% CI: 0.29-0.99], adjusted for other variables significant at the p<0.05 level: HSV-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]. Conclusions: MG infection was reduced among men who were circumcised, adding to the benefits of male circumcision in preventing several sexually transmitted infections.