Background Studies suggest that sexual behavior influences the composition of the male urethral microbiota, but this hypothesis has not been tested.
Methods From 12/2014–5/2018, we enrolled MSM with NGU attending an STD clinic into a cohort study. Men attended five in-clinic visits at 3-week intervals, collected weekly urine specimens at home, and reported daily antibiotics and sex on weekly diaries. We applied broad-range 16S rRNA gene PCR with deep sequencing to urine. We estimated incidence of insertive oral sex (IOS) only, condomless insertive anal intercourse (CIAI) only, and IOS with CIAI (IOS+CIAI) after NGU diagnosis using Poisson regression with robust standard errors. We estimated the association between urethral sexual exposures (referent group=none) in seven 3-day time windows before specimen collection and Shannon Index (diversity) and log10 number of bacterial species (richness) using generalized estimating equations, adjusting for recent antibiotics, age, race/ethnicity, HIV status, and PrEP use. For each exposure category, we tested whether all seven window coefficients were equal to zero (i.e., no overall association) using a Wald test.
Results Among 92 MSM with NGU, median age was 31 (interquartile range [IQR]=28–40); 55% were non-Hispanic white. They contributed 1,095 person-weeks of behavioral data (median=12 diaries/man, IQR=12–13). Incidence of any sex, IOS only, CIAI only, and IOS+CIAI were 1.07 (95% confidence interval [CI]=0.93–1.24), 0.40 (95%CI=0.32–0.49), 0.10 (95%CI=0.07–0.15), and 0.40 (95%CI=0.30–0.52) episodes per person-week, respectively. Among 894 urine specimens (median=10 specimens/man, IQR=8–12), median diversity was 1.33 (IQR=0.76–1.99), and median richness was 14 species (IQR=9–23). Overall, CIAI only (P<0.01 in each model) but not IOS only or IOS+CIAI in the prior 21 days was associated with diversity and log10-richness. Diversity and log10-richness were lower 1–3 days after and higher 16–18 days after CIAI only.
Conclusion Among MSM after NGU, CIAI only in the prior 21 days was independently associated with diversity and richness of the urethral microbiota.
Disclosure No significant relationships.
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