Drover Caitlin M, Srinivasan Sujatha, Tapia Kenneth A, Munch Matthew, Rowlinson Emily, Chambers Laura C, Fiedler Tina L, Lowens M Sylvan, Khosropour Christine M, Manhart Lisa E, Fredricks David N
From the Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, at the time this work was completed. Currently at the Washington State Department of Health, Tumwater.
Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle.
Sex Transm Dis. 2025 May 1;52(5):317-324. doi: 10.1097/OLQ.0000000000002129. Epub 2024 Dec 24.
The etiology of nongonococcal urethritis (NGU) is incompletely understood. We sought to determine if genitourinary bacterial diversity or specific taxa were associated with incident NGU.
From August 2014 to July 2018, men who have sex with women attending a sexual health clinic were clinically evaluated, including Mycoplasma genitalium (MG) and Chlamydia trachomatis (CT) testing, at enrollment and 6 monthly visits. New cases of NGU (≥5 polymorphonuclear leukocytes per high-power field in urethral exudates plus either symptoms or visible discharge) and their visit preceding NGU diagnosis were matched 1:1 to 2 sequential visits without NGU (controls). We determined associations with incident NGU and applied broad-range 16S rRNA gene polymerase chain reaction and sequencing to urine samples from each visit. We used conditional logistic regression to evaluate the association of Shannon Diversity Index, species richness, Haemophilus influenzae , Fannyhessea vaginae, Lactobacillus iners, and Streptococcus mitis group with incident non-CT-non-MG-NGU (NCNM-NGU).
Of 62 matched case-control pairs, median age was 32 years. Higher Shannon Diversity Index the previous month was associated with higher odds of incident NCNM-NGU (adjusted odds ratio [aOR], 2.8 per unit increase; 95% confidence interval [CI], 1.03-7.47), as was F. vaginae at NGU diagnosis (aOR, 5.1; 95% CI, 1.28-20.15), F. vaginae acquisition (aOR, 13.8; 95% CI, 1.96-97.33), and consistent carriage of F. vaginae (aOR, 16.1; 95% CI, 1.66-156.29). Odds of NCNM-NGU were higher when L. iners cleared between visits (aOR, 18.0; 95% CI, 1.08-299.24). Neither the H. influenzae nor S. mitis group was associated with incident NCNM-NGU.
F. vaginae acquisition/detection and L. iners clearance were associated with urethritis. This merits investigation in larger longitudinal studies using species-specific detection methods.
非淋菌性尿道炎（NGU）的病因尚未完全明确。我们试图确定泌尿生殖道细菌多样性或特定分类群是否与新发NGU相关。
2014年8月至2018年7月，对一家性健康诊所中与女性发生性行为的男性进行临床评估，包括在入组时及之后每6个月的随访中检测生殖支原体（MG）和沙眼衣原体（CT）。NGU新病例（尿道分泌物中每高倍视野多形核白细胞≥5个，伴有症状或可见分泌物）及其NGU诊断前的就诊情况与2次连续无NGU就诊情况（对照）进行1:1匹配。我们确定了与新发NGU的关联，并对每次就诊时的尿液样本应用广谱16S rRNA基因聚合酶链反应和测序。我们使用条件逻辑回归来评估香农多样性指数、物种丰富度、流感嗜血杆菌、阴道芬尼希菌、惰性乳杆菌和缓症链球菌群与新发非CT非MG-NGU（NCNM-NGU）的关联。
在62对匹配的病例对照中，中位年龄为32岁。前一个月较高的香农多样性指数与新发NCNM-NGU的较高几率相关（调整优势比[aOR]，每单位增加2.8；95%置信区间[CI]，1.03-7.47），NGU诊断时的阴道芬尼希菌也是如此（aOR，5.1；95%CI，1.28-20.15），阴道芬尼希菌的获得（aOR，13.8；95%CI，1.96-97.33），以及阴道芬尼希菌的持续携带（aOR，16.1；95%CI，1.66-156.29）。就诊期间惰性乳杆菌清除时NCNM-NGU的几率更高（aOR，18.；%CI，1.08-299.24）。流感嗜血杆菌和缓症链球菌群均与新发NCNM-NGU无关。
阴道芬尼希菌的获得/检测和惰性乳杆菌的清除与尿道炎相关。这值得在使用物种特异性检测方法的更大规模纵向研究中进行调查。
