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David H. Spach, MD; Ann E. Stapleton, MD; Walter E. Stamm, MD

JAMA. 1992;267(5):679-681.

Abstract
Objective.
—To determine whether lack of circumcision increases the risk of urinary tract infection (UTI) in adult men.

Design and Setting.
—Retrospective case-control study (1987-1990) at a sexually transmitted disease clinic in Seattle, Wash.

Patients.
—Twenty-six men (median age, 30 years) who had microbiologically confirmed symptomatic UTIs (cases) compared with 52 men (median age, 32 years) who had urinary symptoms but negative urine cultures (controls).

Main Outcome Measure.
—Circumcision status among bacteriuric and nonbacteriuric men.

Results.
—The bacteriuric and nonbacteriuric groups were similar in age, race, sexual activity, and sexual preference. Eight (31%) of the 26 bacteriuric men were uncircumcised compared with 6 (12%) of the 52 nonbacteriuric men (P =.037; odds ratio, 3.4; 95% confidence interval, 1.0 to 11.2). Among 19 patients infected with gram-negative bacilli, 8 (42%) of 19 were uncircumcised vs 6 (12%) of 52 nonbacteriuric men (P =.004; odds ratio, 5.6; 95% confidence interval, 1.6 to 19.4). Escherichia coli was the most common urinary isolate (15 of 26 isolates), and the majority of E coli strains possessed urovirulence determinants, including mannoseresistant hemagglutination (10 of 14 isolates), F fimbriae (11 of 14 isolates), P fimbriae (6 of 14 isolates), hemolysin (10 of 14 isolates), and aerobactin (8 of 14 isolates). Although all 26 bacteriuric men had urethral cultures negative for Chlamydia trachomatis and Neisseria gonorrhoeae, Gram-stained urethral smears showed evidence of urethritis in 17 (68%) of 25 men.

Conclusions.
—(1) Lack of circumcision increases the risk of UTI in young adult men. (2) The majority of these infections result from urovirulent strains of E coli. (3) Clinically, these infections often produce urethritis as well as UTI.

(JAMA. 1992;267:679-681)

Author Affiliations
From the Division of Infectious Diseases (Drs Spach, Stapleton, and Stamm) and the Department of Medicine (Dr Stamm), University of Washington Medical Center, Seattle.

Footnotes
Presented as an abstract at the 31st Interscience Conference on Antimicrobial Agents and Chemotherapy, Chicago, Ill, October 2, 1991.

Reprint requests to Division of Infectious Diseases, ZA-89, Harborview Medical Center, 325 Ninth Ave, Seattle, WA 98104 (Dr Stamm).

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