Microbiological Analysis of the Preputial Slit in Anambra State Nigeria: Why Neonatal Circumcision?

Abstract

Background: Circumcision is one of the most widely performed and controversial procedures globally. While often carried out for sociocultural and religious reasons, it is also promoted as prophylaxis against urinary tract infections (UTIs), sexually transmitted infections (STIs), and HIV. The role of the preputial microbiome in these indications remains debated. Objective: This study aimed to assess and characterize microbial species from the preputial sac of neonates undergoing circumcision and to determine their antibiotic susceptibility patterns. Methods: A prospective cross-sectional study was conducted at a health facility between September and November 2024. Thirty-six male neonates undergoing circumcision were recruited. Swabs from the preputial sac were cultured on selective media, and isolates were identified by Gram staining and standard biochemical tests. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disc diffusion method according to CLSI guidelines. Data on neonatal and maternal factors were collected through structured proforma. Results: Eight different bacteria species were isolated, with Coagulase-Negative Staphylococcus and Escherichia coli being most common (22% each). Six samples (16.7%) showed no growth. Gentamicin exhibited the highest sensitivity (50%), while high resistance rates were recorded for ampicillin and amoxicillin-clavulanic acid (80.6%). Maternal and neonatal factors, including prior antibiotic use, maternal infection, or hospital admission, did not significantly influence microbial presence or antibiotic susceptibility. Conclusion: The preputial sac harbors primarily commensal microorganisms, with high levels of antibiotic resistance observed. Findings question the justification of neonatal circumcision as prophylaxis for UTI or STI prevention and highlight the need for reconsideration of its routine practice.