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Bacterial vaginosis-associated bacteria in cisgender men who have sex with women: prevalence, association with non-gonococcal urethritis and natural history
  1. Kaitlin A Zinsli1,
  2. Sujatha Srinivasan2,
  3. Jennifer E Balkus1,
  4. Laura C Chambers1,
  5. M Sylvan Lowens3,
  6. Jennifer Morgan3,
  7. Emily Rowlinson1,
  8. Tashina S Robinson1,
  9. Sarah S Romano1,
  10. Matthew M Munch2,
  11. Lisa E Manhart1,
  12. David N Fredricks2,4
  1. 1 Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
  2. 2 Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
  3. 3 HIV/STD Program, Public Health - Seattle & King County, Seattle, Washington, USA
  4. 4 Department of Medicine, University of Washington, Seattle, Washington, USA
  1. Correspondence to Ms Kaitlin A Zinsli, Epidemiology, University of Washington Department of Epidemiology, Seattle, Washington, USA; kaz2{at}


Objectives Bacterial vaginosis-associated bacterium 2 (BVAB2), Mageeibacillus indolicus and Sneathia spp are highly predictive of bacterial vaginosis (BV) in cisgender women. They have been associated with non-gonococcal urethritis (NGU) in cisgender men in some but not all populations. We evaluated this association in a cross-sectional study of cisgender men who have sex with women only (MSW).

Methods MSW without gonorrhoea attending a sexual health clinic (SHC) from 2014 to 2018 completed a computer-assisted self-interview, clinical interview and examination. NGU was defined as ≥5 polymorphonuclear leucocytes/high-power field in urethral exudates plus either urethral symptoms or visible discharge. Urine was tested for Chlamydia trachomatis and Mycoplasma genitalium using Aptima (Hologic) and for BVAB2, M. indolicus, Sneathia spp, Trichomonas vaginalis, Ureaplasma urealyticum, Haemophilus influenzae, herpes simplex virus and adenovirus using quantitative PCR.

Results Of 317 MSW age 17–71, 67 (21.1%) had Sneathia spp, 36 (11.4%) had BVAB2, and 17 (5.4%) had M. indolicus at enrolment. Having ≥3 partners in the past 2 months was the only characteristic that was more common among MSW with than those without these bacteria (BVAB2: 47% vs 23%, M. indolicus: 53% vs 24%, Sneathia spp: 42% vs 22%; p≤0.03 for all). One-hundred seventeen men (37%) were diagnosed with NGU at enrolment. There was no significant association of BVAB2, M. indolicus or Sneathia spp with NGU (adjusted OR=0.59, 95% CI 0.14 to 2.43; aOR=3.40, 95% CI 0.68 to 17.06; aOR=0.46, 95% CI 0.16 to 1.27). Of 109 MSW with monthly samples, 34 (31.2%) had one of the bacteria at one or more follow-up visits, 22 of which were co-colonised with >1. Median persistence over 6 months did not differ significantly (BVAB2=30.5 days, IQR=28–87; M. indolicus=87 days, IQR=60–126; Sneathia spp=70 days, IQR=30–135; p≥0.20 for each comparison).

Conclusions Neither BVAB2, M. indolicus nor Sneathia spp were associated with increased risk of prevalent NGU in MSW attending an SHC.

  • Bacterial Infections
  • Epidemiology
  • Vaginosis, Bacterial

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Handling editor Jane S Hocking

  • LEM and DNF contributed equally.

  • Contributors LEM, DNF and SS conceived the parent study. LCC, MSL, JM, TSR and SSR performed the data collection. SS and MMM performed laboratory assays. KAZ performed all analyses of the data and wrote the first draft of the manuscript. All authors contributed substantively to the final version of the manuscript and read and approved the final manuscript. LEM is the acting guarantor for this manuscript.

  • Funding This work was supported by the National Institute of Allergy and Infectious Diseases (R01AI110666 and U19AI113173). Study data were collected and managed using REDCap electronic data capture tools hosted at the Institute of Translational Health Sciences through a grant from the National Center for Advancing Translational Sciences (UL1TR002319).

  • Competing interests LEM has received research support and honoraria from Hologic and Nabriva Therapeutics.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.