Comparison of the penile microbiome in infant male circumcision: Mogen clamp versus Shangring

Juan E. Salazar, Antibiotic Resistance Action Center, Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, DC, 20052, USA.
Daniel E. Park, Antibiotic Resistance Action Center, Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, DC, 20052, USA.
Nahid Punjani, Department of Urology, Weill Cornell Medicine of Cornell University, New York-Presbyterian Hospital, New York, NY, USA.
Tony Pham, Antibiotic Resistance Action Center, Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, DC, 20052, USA.
Maliha Aziz, Antibiotic Resistance Action Center, Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, DC, 20052, USA.
Godfrey Kigozi, Rakai Health Sciences Program, Uganda Virus Research Institute, Entebbe, Uganda.
Ronald H. Gray, Rakai Health Sciences Program, Uganda Virus Research Institute, Entebbe, Uganda; Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, USA.
Stephen D. Kiboneka, Rakai Health Sciences Program, Uganda Virus Research Institute, Entebbe, Uganda.
Marc Goldstein, Department of Urology, Weill Cornell Medicine of Cornell University, New York-Presbyterian Hospital, New York, NY, USA.
Philip S. Li, Department of Urology, Weill Cornell Medicine of Cornell University, New York-Presbyterian Hospital, New York, NY, USA.
Richard Lee, Department of Urology, Weill Cornell Medicine of Cornell University, New York-Presbyterian Hospital, New York, NY, USA.
Cindy M. Liu, Antibiotic Resistance Action Center, Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, DC, 20052, USA. Electronic address: cindyliu@gwu.edu.

Document Type

Journal Article

Publication Date

6-25-2024

Journal

EBioMedicine

Volume

105

DOI

10.1016/j.ebiom.2024.105216

Keywords

Anaerobe; Early infant male circumcision (EIMC); Infant coronal sulcus microbioime; Infant penile microbiome; Mogen clamp; Shangring; Tetanus; Uropathogen

Abstract

BACKGROUND: This study aimed to characterise the infant penile (coronal sulcus) microbiome and the effects of early infant male circumcision (EIMC), following a standard surgical method (Mogen Clamp) and a non-surgical alternative (ShangRing). METHODS: We collected coronal sulcus swabs at baseline and on days 7 and 14 post-circumcision from infants assigned to receive EIMC by Mogen Clamp (n = 15) or ShangRing (n = 15), in a randomised trial in Rakai and Kakuuto, Uganda. We used 16S rRNA gene-based sequencing and broad-coverage qPCR to characterise the infant penile microbiome and assess the effects of EIMC in both study arms. FINDINGS: Prior to EIMC, the infant penile microbiome had a mixture of facultative and strict anaerobes. In both study arms, EIMC caused penile microbiome proportional abundance changes characterised by decreases in penile anaerobes [ShangRing Prevotella: -15.0%, (SD = 19.1); Mogen clamp Prevotella: -3.6% (11.2); ShangRing Veillonella: -11.3% (17.2); Mogen clamp Veillonella: -2.6% (11.8)] and increases in skin-associated facultative anaerobes [ShangRing Corynebacterium: 24.9%, (22.4); Mogen clamp Corynebacterium: 4.7% (21.3); ShangRing Staphylococcus: 21.1% (20.5); Mogen clamp Staphylococcus: 18.1% (20.1)]. Clostridium tetani was not detected during the study. INTERPRETATION: Mogen Clamp and ShangRing EIMC both changed the composition of the infant penile microbiome by reducing the proportional abundances of anaerobes and uropathogens, which is consistent with medical male circumcision findings in adults. C. tetani was not increased by either EIMC method. FUNDING: Bill and Melinda Gates Foundation.

Department

Environmental and Occupational Health

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