Investig Clin Urol.  2019 Mar;60(2):127-132. 10.4111/icu.2019.60.2.127.

Microbiology of smegma: Prospective comparative control study

• Chung JM
• Park CS
• Lee SD

• KMID: 2438824
• DOI: http://doi.org/10.4111/icu.2019.60.2.127

Abstract

PURPOSE
The aim of the study was to investigate the common bacteria found in the smegma in the subpreputial space of asymptomatic boys prospectively, and to determine the difference of those bacteria according to the presence of smegma.
MATERIALS AND METHODS
In our institution, 40 boys who performed penoplasty were recruited into the study. Swab was done using aseptic techniques on smegma and glans in the operation room. According to the presence of smegma in the subpreputial space, we classified glans as a group S (with smegma, n=20) and group C (without smegma, n=20). The swabs were immediately sent to microbiology laboratory for microscopy, culture, and sensitivity tests.
RESULTS
The mean age was 30.4±26.4 months. Thirty-one bacteria were isolated from smegma, comprising 15 gram-positive species (48.4%) and 16 gram-negative species (51.6%). The most commonly isolated gram-negative bacterium was Escherichia coli (25.8%), while the commonly isolated gram-positive bacteria were Enterococcus faecalis (19.4%) and Enterococcus avium (12.9%). Most of the bacterial isolates were multi-drug-resistant (61.3%). In group S, 12 boys had 22 bacterial isolates in the glans. The commonly isolated bacteria were E. coli (27.3%), E. avium (22.7%) and E. faecalis (18.2%). In group C, 13 boys had 21 bacterial isolates in the glans. The most commonly isolated bacterium was E. faecalis (28.6%).
CONCLUSIONS
Smegma in the subpreputial space of children was colonized by many kinds of uropathogen.

Keyword

Foreskin; Microbiology; Smegma

MeSH Terms

Bacteria
Child
Colon
Enterococcus
Enterococcus faecalis
Escherichia coli
Foreskin
Gram-Positive Bacteria
Humans
Microscopy
Prospective Studies*
Smegma*

Reference

1. Ginsburg CM, McCracken GH Jr. Urinary tract infections in young infants. Pediatrics. 1982; 69:409–412. PMID: 7070887.

2. Wiswell TE, Smith FR, Bass JW. Decreased incidence of urinary tract infections in circumcised male infants. Pediatrics. 1985; 75:901–903. PMID: 3991278.

3. Wiswell TE, Hachey WE. Urinary tract infections and the uncircumcised state: an update. Clin Pediatr (Phila). 1993; 32:130–134. PMID: 8453827.

4. Wiswell TE, John K. Lattimer lecture. Prepuce presence portends prevalence of potentially perilous periurethral pathogens. J Urol. 1992; 148:739–742. PMID: 1386390.

5. Glennon J, Ryan PJ, Keane CT, Rees JP. Circumcision and periurethral carriage of Proteus mirabilis in boys. Arch Dis Child. 1988; 63:556–557. PMID: 3291784.

6. Herzog LW. Urinary tract infections and circumcision. A case-control study. Am J Dis Child. 1989; 143:348–350. PMID: 2624614.

7. Fussell EN, Kaack MB, Cherry R, Roberts JA. Adherence of bacteria to human foreskins. J Urol. 1988; 140:997–1001. PMID: 2902235.

8. Fleiss PM, Hodges FM, Van Howe RS. Immunological functions of the human prepuce. Sex Transm Infect. 1998; 74:364–367. PMID: 10195034.

9. Van Howe RS, Hodges FM. The carcinogenicity of smegma: debunking a myth. J Eur Acad Dermatol Venereol. 2006; 20:1046–1054. PMID: 16987256.

10. Parkash S, Jeyakumar S, Subramanyan K, Chaudhuri S. Human subpreputial collection: its nature and formation. J Urol. 1973; 110:211–212. PMID: 4722614.

11. Cold CJ, Taylor JR. The prepuce. BJU Int. 1999; 83(Suppl 1):34–44.

12. Sonnex C, Croucher PE, Dockerty WG. Balanoposthitis associated with the presence of subpreputial “smegma stones”. Genitourin Med. 1997; 73:567. PMID: 9582487.

13. Kayaba H, Tamura H, Kitajima S, Fujiwara Y, Kato T, Kato T. Analysis of shape and retractability of the prepuce in 603 Japanese boys. J Urol. 1996; 156:1813–1815. PMID: 8863623.

14. Bauer AW, Kirby WM, Sherris JC, Turck M. Antibiotic susceptibility testing by a standardized single disk method. Am J ClinPathol. 1966; 45:493–496.

15. Cooper CS, Storm DW. Infection and inflammation of the pediatric genitourinary tract. In : Wein AJ, Kavoussi LR, Partin AW, Peters CA, editors. Campbell-Walsh urology. 11th ed. Philadelphia: Elsevier;2016. p. 2926–2948.

16. Wiswell TE. The prepuce, urinary tract infections, and the consequences. Pediatrics. 2000; 105:860–862. PMID: 10742334.

17. Adegbola RA, Old DC, Senior BW. The adhesins and fimbriae of Proteus mirabilis strains associated with high and low affinity for the urinary tract. J Med Microbiol. 1983; 16:427–431. PMID: 6139485.

18. Verit A, Zeyrek FY, Mordeniz C, Ciftci H, Savas M. Status of high-risk oncogenic human papillomavirus subtypes harbored in the prepuce of prepubertal boys. Urology. 2012; 80:423–426. PMID: 22554592.

19. Schoen EJ, Colby CJ, Ray GT. Newborn circumcision decreases incidence and costs of urinary tract infections during the first year of life. Pediatrics. 2000; 105:789–793. PMID: 10742321.

20. Oster J. [The prepuce in Danish schoolboys. Incidence of preputial adhesion, phimosis, and smegma]. Nord Med. 1968; 80:1318–1322. Danish. PMID: 5688182.

21. Bollgren I, Winberg J. The periurethral aerobic bacterial flora in healthy boys and girls. Acta Paediatr Scand. 1976; 65:74–80. PMID: 766562.

22. Prakash S, Rao R, Venkatesan K, Ramakrishnan S. Sub-preputial wetness--its nature. Ann Natl Med Sci (India). 1982; 18:109–112.

23. Cohn BA. In search of human skin pheromones. Arch Dermatol. 1994; 130:1048–1051. PMID: 8053704.

24. Waskett JH, Morris BJ. Re: 'RS Van Howe, FM Hodges. The carcinogenicity of smegma: debunking a myth An example of myth and mythchief making. J Eur Acad Dermatol Venereol. 2008; 22:131. author reply 131-2. PMID: 18182000.

25. Tobgi RS, Samaranayake LP, MacFarlane TW. In vitro susceptibility of Candida species to lysozyme. Oral Microbiol Immunol. 1988; 3:35–39. PMID: 3268748.

26. Fröhlich E, Schaumburg-Lever G, Klessen C. Immunelectron microscopic localization of cathepsin B in human exocrine glands. J Cutan Pathol. 1993; 20:54–60. PMID: 8468418.

27. Ahmed AA, Nordlind K, Schultzberg M, Lidén S. Immunohistochemical localization of IL-1 alpha-, IL-1 beta-, IL-6- and TNF-alpha-like immunoreactivities in human apocrine glands. Arch Dermatol Res. 1995; 287:764–766. PMID: 8554390.

28. Anyanwu LJ, Kashibu E, Edwin CP, Mohammad AM. Microbiology of smegma in boys in Kano, Nigeria. J Surg Res. 2012; 173:21–25. PMID: 21872267.

29. Balci M, Tuncel A, Baran I, Guzel O, Keten T, Aksu N, et al. High-risk oncogenic human Papilloma virus infection of the foreskin and microbiology of smegma in prepubertal boys. Urology. 2015; 86:368–372. PMID: 26199167.

30. Ahoyo AT, Baba-Moussa L, Anago AE, Avogbe P, Missihoun TD, Loko F, et al. [Incidence of infections dues to Escherichia coli strains producing extended spectrum betalactamase, in the Zou/Collines Hospital Centre (CHDZ/C) in Benin]. Med Mal Infect. 2007; 37:746–752. French. PMID: 17434702.