JCM Accepted Manuscript Posted Online 1 April 2015 J. Clin. Microbiol. doi:10.1128/JCM.00579-15 Copyright © 2015, American Society for Microbiology. All Rights Reserved.
1
Colonization with the Man's Escherichia coli Strain among Female Sex Partners of Men with
2
Febrile Urinary Tract Infection
3 4
Peter Ulleryd1,2, * (#), Torsten Sandberg2, Flemming Scheutz3, Connie Clabots4, Brian D.
5
Johnston4,5, Paul Thuras4,6, and James R. Johnson4,5
6 7
1
8
Sweden
9
2
Department of Communicable Disease Control and Prevention, Region Västra Götaland,
Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy,
10
University of Gothenburg, Gothenburg, Sweden
11
3
12
Statens Serum Institute, Copenhagen, Denmark
13
4
Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
14
5
Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
15
6
Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota, USA
WHO Collaborating Centre for Reference and Research on Escherichia and Klebsiella,
16 17
Keywords: UTI, sex partners, E. coli, colonization, transmission, typing
18 19
Running title: E. coli in sex partners of men with UTI
20 21
Corresponding author: (#) Peter Ulleryd, Department of Communicable Disease Control and
22
Prevention, Region Västra Götaland, Kaserntorget 11 B, 411 18 Gothenburg, Sweden.
23
*At present working at WHO HQ, Geneva, Switzerland ([email protected])
24 25
1
26
ABSTRACT
27 28
Of 23 unique Escherichia coli strains from 10 men with febrile urinary tract infection (UTI)
29
and their female sex partners, 6 strains (all UTI-causing) were shared between partners.
30
Molecularly, the 6 shared strains appeared more virulent than the 17 non-shared strains, being
31
associated with phylogenetic group B2, sequence types ST73 and ST127, and multiple
32
specific virulence genes. This supports UTI as sometimes being sexually transmitted.
2
33
Introduction. Escherichia coli is the leading cause of urinary tract infections (UTIs), a
34
tremendously common and costly illness (1). Although the causative E. coli strains usually
35
derive from the host's own gastrointestinal microbiota (2, 3), their more proximate reservoirs
36
are poorly understood.
37 38
Sharing of E. coli strains, whether pathogenic or not, is common among closely associated
39
hosts, including pets and sex partners (4-19). However, strain sharing between a man with E.
40
coli UTI and his healthy female sexual partner (FSP) has not been reported. We capitalized on
41
a large cohort of men with E. coli febrile UTI (FUTI) to assess this phenomenon's frequency
42
and the characteristics of any such shared strains.
43 44
Subjects and specimens. Ten men with community-acquired E. coli FUTI and a FSP who was
45
willing to participate in the study were identified within a larger cohort study of male FUTI at
46
Sahlgrenska University Hospital, Gothenburg, Sweden, 1993-1996 (21, 22). Men had to have
47
a temperature ≥ 38.0 ˚C, at least one urinary-tract-referable symptom or sign (frequency,
48
dysuria, flank pain, or costovertebral angle tenderness), and ≥ 104 colony-forming units
49
(cfu)/mL of a uropathogen on urine culture (21, 22). Consenting subjects underwent culture
50
surveillance of urine, feces, and (for FSPs) the vagina initially and with any subsequent UTI
51
episode in either partner.
52 53
Midstream urine samples, collected per protocol, were kept at 4°C until cultured
54
semiquantitatively on blood and cysteine–lactose–electrolyte-deficient agar. Significant
55
growth was defined as ≥ 104 cfu/mL of E. coli. The last free-lying colony was saved.
56
3
57
Males self-collected rectal samples per protocol. An author (P.U.) collected vaginal and rectal
58
samples from FSPs. Swabs were streaked to modified Conradi-Drigalski agar, for overnight
59
incubation. The last three free-lying colonies on each plate, plus any morphologically distinct
60
colonies, were picked for analysis; this provides ≥ 97% sensitivity for detecting the
61
quantitatively predominant clone in rectal samples (23). Confirmed E. coli isolates were
62
stored in agar stabs (24).
63 64
Isolate characterization. E. coli isolates underwent O-typing or full O:K:H-serotyping at
65
Statens Serum Institute, Copenhagen, DK. One colony per O:K:H-serotype per specimen, and
66
colonies differing by O-type from the index FUTI isolate, underwent molecular typing,
67
including XbaI pulsed-field gel electrophoresis (PFGE) profiling (25). Pulsotypes (here
68
equated with strains) were assigned based on ≥ 94% profile similarity to index profiles within
69
a large PFGE database (26).
70 71
One representative per sample per PFGE type underwent PCR-based major phylogenetic
72
group determination (25). Extended virulence genotypes were determined by multiplex PCR
73
(27-29). Sequence type (ST) and clonal complex (CC; cluster of closely-related STs) was
74
determined by PCR (27), fumC-fimH sequence-analysis (30), and/or multi-locus sequence
75
typing (http://mlst.warwick.ac.uk).
76 77
Statistical methods. Comparisons of proportions and virulence score were tested using
78
Fisher's exact test and the Mann-Whitney U test, respectively, with significance set at P < .05.
79 80
Study population. The 10 index men with FUTI had a median age of 55 (range, 37–69) and a
81
median temperature of 39.3°C (range, 39.0–40.5) (Table S1). None affirmed anal intercourse
4
82
during the preceding 6 months. Two patients had voiding problems suggesting prostatism.
83
Only 3 had possible UTI-predisposing conditions: post-operative urethral catheterization 3
84
days pre-FUTI episode, diabetes mellitus, and a small bladder adenoma. The 10 FSPs' median
85
age was 48.5 years (range, 32–62). All denied UTI symptoms and antibiotic treatment in the
86
preceding three months.
87 88
Culture results. Culture surveillance was done once for 7 couples and repeatedly (over 1 to 22
89
months) for 3 couples. Of the 76 total rectal, vaginal, and urine cultures, 59 (78%) yielded E.
90
coli. Sequential serotyping and PFGE analysis resolved 23 unique E. coli strains (Figure 1),
91
which were predominantly from phylogroup B2 (12, 52%) and represented 15 CCs.
92
Seventeen (74%) qualified molecularly as ExPEC.
93 94
Strain sharing. Of the 23 strains, 6 occurred in both members of a particular couple, and only
95
in that couple (Figure 1). All 6 (100%) shared strains, vs. 4 (24%) non-shared strains,
96
represented the male's index FUTI isolate (P = .002) (Table 1). Shared strains also were more
97
likely to cause asymptomatic bacteriuria (ABU) or acute cystitis, and to colonize the woman's
98
rectum and/or vagina.
99 100
Longitudinal follow-up. During serial surveillance, in couples #10 and #29 the shared strains
101
caused sustained co-colonization and recurrent symptomatic UTI and/or ABU (Table S2-3).
102
In couple #95, at the time of the man's E. coli FUTI episode the FSP was colonized
103
extensively with the index E. coli strain, which 3 weeks later persisted in her despite being
104
undetectable in the man.
105
5
106
Characteristics of shared strains. Compared with non-shared strains, the 6 shared strains more
107
often represented phylogroup B2 and uropathogenic lineages CC73 or CC127, and more often
108
contained papG III, sfa/foc, sfaS, hlyD, cnf1, iroN, and malX (Table S4).
109 110
Comment. This in-depth microbiological survey of 10 men with E. coli FUTI and their
111
healthy FSPs identified frequent (60%) co-colonization of FSPs with the man's index E. coli
112
strain. This equals or exceeds the prevalence of such co-colonization among male partners of
113
women with E. coli cystitis (5, 11, 12).
114 115
Such strain sharing may result from person-to-person transmission or parallel acquisition. Co-
116
colonization between sex partners has been associated with specific sex practices (12). We
117
lacked data regarding sexual practices other than anal intercourse (which our subjects denied),
118
so cannot comment on behavioral correlates of co-colonization.
119 120
The potential clinical implications of co-colonization include risks of (i) acute UTI in a FSP
121
due to the male's UTI strain, and (ii) reintroduction of the strain into the index subject from a
122
co-colonized partner. The first scenario occurred here (couple #10). Whether decolonization
123
of co-colonized sex partners is warranted deserves study.
124 125
As in previous studies (6, 7, 12, 31), shared strains were distributed more broadly, caused
126
more infections, and exhibited more uropathogenic traits than non-shared strains. This
127
supports that certain E. coli traits and lineages promote both UTI pathogenesis and intestinal
128
colonization (32). Conceivably, interventions directed toward these traits and/or lineages
129
could prevent UTI by blocking both proceesses.
130
6
131
Since we investigated middle-aged male FUTI patients without serious medical or urological
132
compromise, and their middle-aged FSPs, our results cannot be extrapolated to other forms of
133
UTI or host populations. Additionally, since our rectal sampling method detects mainly
134
dominant fecal E. coli clones (23), we likely underestimated the true frequency of co-
135
colonization (33).
136 137
Summary. We demonstrated frequent sharing of the causative E. coli strain between men with
138
FUTI and their FSPs, which supports male UTI as sometimes being sexually transmitted.
139
Strain sharing was more common and extensive for classical urovirulent strains, suggesting
140
that "urovirulence" traits may also promote colonization and transmission.
141
7
142
ACKNOWLEDGMENTS
143 144
This material is based upon work supported by The Medical Society of Gothenburg, Sweden
145
(P.U.), and the Office of Research and Development, Medical Research Service, Department
146
of Veterans Affairs, USA (J.R.J.). The technical assistance of Susanne Jespersen, Statens
147
Serum Institute, Copenhagen, Denmark is highly appreciated.
148
8
149 150
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13
251
TABLE 1. Colonization and clinical characteristics of 23 Escherichia coli strains from 10
252
men with FUTIa and their female sexual partners in relation to strain sharing.
253 Prevalence of characteristic, no. (column %) Characteristic
Total
Non-shared
Shared
P value,
(n = 23)
strains
strains
non-
(n = 17)
(n = 6)
shared vs. sharedb
Male, any site
18 (78)
12 (71)
6 (100)
Rectum
11 (48)
10 (59)
1 (17)
FUTIa
10 (44)
4 (24)
6 (100)
.002
2 (9)
0 (0)
2 (33)
.06
11 (48)
5 (29)
6 (100)
.005
Rectum
10 (44)
5 (29)
5 (83)
.052
Vagina
4 (17)
0 (0)
4 (67)
.002
Acute cystitis during follow-up
1 (4)
0 (0)
1 (17)
ABU during follow-upc
2 (9)
0 (0)
2 (33)
ABU during follow-upc Female, any site
254 255
.06
a
FUTI, febrile urinary tract infection.
256
b
257
c
P values (by Fisher's exact test) are shown when P < .10.
ABU, asymptomatic bacteriuria. 14
258
FIG 1. Pulsed-field gel electrophoresis (PFGE) profiles of Escherichia coli isolates from
259
10 men with febrile urinary tract infection and their female sex partners. Dendrogram is
260
based on pairwise similarity relationships among XbaI PFGE profiles, as reflected in Dice
261
similarity coefficients. Colored rectangles enclose profiles of the same pulsotype. Labels to
262
right of dendrogram show the couple #. PFGE column lists pulsotype designation, which for
263
shared strains is shown also to the right of each rectangle. The red circle identifies the sole
264
instance of putative strain sharing across couples (couples 29 vs. 95), which likely was
265
spurious (based on differences in virulence genotype).
266
(Image on next page)
267
15
268
16
PFGExba 100
90
80
70
60
50
PFGExba
PFGE
Host Y
Sample
Symptoms
Sampling
1395
29 Female
Vaginal
Asymptomatic
4th
1395
29 Female
Urine
Cystitis
2nd
1395
29 Female
Urine
Asymptomatic
4th
1395
29 Female
Urine
Cystitis
5th
1395
29 Female
Fecal
Asymptomatic
4th
1395
29 Female
Vaginal
Asymptomatic
4th
1395
29 Female
Vaginal
Asymptomatic
4th
1395
29 Male
Urine
Asymptomatic
2nd
1395
29 Male
Urine
Asymptomatic
3rd
1395
29 Male
Urine
Febrile UTI
Initial
1395
29 Male
Fecal
Febrile UTI
Initial
1395
29 Female
Fecal
Cystitis
5th
1395
29 Male
Fecal
Asymptomatic
4th
1395
29 Male
Fecal
Asymptomatic
2nd
1399
125 Male
Urine
Febrile UTI
Initial
1399
125 Female
Fecal
Asymptomatic
Initial
1401
149 Male
Urine
Febrile UTI
Initial
634
149 Male
Fecal
Febrile UTI
Initial
1394
10 Male
Urine
Febrile UTI
3rd
1394
10 Male
Blood
Febrile UTI
4th
1394
10 Male
Urine
Febrile UTI
4th
1394
10 Male
Urine
Asymptomatic
2nd
1394
10 Female
Fecal
Asymptomatic
5th
1394
10 Female
Fecal
Asymptomatic
2nd
1394
10 Female
Vaginal
Asymptomatic
5th
1394
10 Female
Vaginal
Asymptomatic
2nd
1414
82 Female
Fecal
Asymptomatic
Initial
1099
10 Male
Fecal
Asymptomatic
5th
1373
103 Male
Urine
Febrile UTI
Initial
1373
103 Male
Fecal
Febrile UTI
Initial
1383
82 Male
Fecal
Febrile UTI
Initial
1383
82 Male
Urine
Febrile UTI
Initial
1398
121 Male
Urine
Febrile UTI
Initial
854
95 Male
Urine
Febrile UTI
Initial
854
95 Female
Vaginal
Asymptomatic
Initial
854
95 Female
Urine
Asymptomatic
2nd
854
95 Female
Urine
Asymptomatic
Initial
854
29 Female
Fecal
Cystitis
5th
854
95 Female
Fecal
Asymptomatic
Initial
1396
81 Male
Urine
Febrile UTI
Initial
1396
81 Female
Vaginal
Asymptomatic
Initial
1400
131 Male
Urine
Febrile UTI
Initial
1400
131 Female
Fecal
Asymptomatic
Initial
1411
103 Female
Fecal
Asymptomatic
Initial
1411
103 Female
Vaginal
Asymptomatic
Initial
1409
125 Male
Fecal
Febrile UTI
Initial
1405
121 Male
Fecal
Febrile UTI
Initial
1408
10 Male
Fecal
Febrile UTI
Initial
1406
121 Female
Vaginal
Asymptomatic
Initial
1406
121 Female
Fecal
Asymptomatic
Initial
1413
149 Female
Fecal
Asymptomatic
Initial
1407
131 Male
Fecal
Febrile UTI
Initial
762
81 Male
Fecal
Febrile UTI
Initial
1412
149 Male
Fecal
Febrile UTI
Initial
1395
1399
1394
854 1396 1400
1
Colonization with the Man's Escherichia coli Strain among Female Sex Partners of Men with
2
Febrile Urinary Tract Infection
3 4
Peter Ulleryd1,2, * (#), Torsten Sandberg2, Flemming Scheutz3, Connie Clabots4, Brian D.
5
Johnston4,5, Paul Thuras4,6, and James R. Johnson4,5
6 7
1
8
Sweden
9
2
Department of Communicable Disease Control and Prevention, Region Västra Götaland,
Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy,
10
University of Gothenburg, Gothenburg, Sweden
11
3
12
Statens Serum Institute, Copenhagen, Denmark
13
4
Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
14
5
Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
15
6
Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota, USA
WHO Collaborating Centre for Reference and Research on Escherichia and Klebsiella,
16 17
Keywords: UTI, sex partners, E. coli, colonization, transmission, typing
18 19
Running title: E. coli in sex partners of men with UTI
20 21
Corresponding author: (#) Peter Ulleryd, Department of Communicable Disease Control and
22
Prevention, Region Västra Götaland, Kaserntorget 11 B, 411 18 Gothenburg, Sweden.
23
*At present working at WHO HQ, Geneva, Switzerland ([email protected])
24 25
1
26
ABSTRACT
27 28
Of 23 unique Escherichia coli strains from 10 men with febrile urinary tract infection (UTI)
29
and their female sex partners, 6 strains (all UTI-causing) were shared between partners.
30
Molecularly, the 6 shared strains appeared more virulent than the 17 non-shared strains, being
31
associated with phylogenetic group B2, sequence types ST73 and ST127, and multiple
32
specific virulence genes. This supports UTI as sometimes being sexually transmitted.
2
33
Introduction. Escherichia coli is the leading cause of urinary tract infections (UTIs), a
34
tremendously common and costly illness (1). Although the causative E. coli strains usually
35
derive from the host's own gastrointestinal microbiota (2, 3), their more proximate reservoirs
36
are poorly understood.
37 38
Sharing of E. coli strains, whether pathogenic or not, is common among closely associated
39
hosts, including pets and sex partners (4-19). However, strain sharing between a man with E.
40
coli UTI and his healthy female sexual partner (FSP) has not been reported. We capitalized on
41
a large cohort of men with E. coli febrile UTI (FUTI) to assess this phenomenon's frequency
42
and the characteristics of any such shared strains.
43 44
Subjects and specimens. Ten men with community-acquired E. coli FUTI and a FSP who was
45
willing to participate in the study were identified within a larger cohort study of male FUTI at
46
Sahlgrenska University Hospital, Gothenburg, Sweden, 1993-1996 (21, 22). Men had to have
47
a temperature ≥ 38.0 ˚C, at least one urinary-tract-referable symptom or sign (frequency,
48
dysuria, flank pain, or costovertebral angle tenderness), and ≥ 104 colony-forming units
49
(cfu)/mL of a uropathogen on urine culture (21, 22). Consenting subjects underwent culture
50
surveillance of urine, feces, and (for FSPs) the vagina initially and with any subsequent UTI
51
episode in either partner.
52 53
Midstream urine samples, collected per protocol, were kept at 4°C until cultured
54
semiquantitatively on blood and cysteine–lactose–electrolyte-deficient agar. Significant
55
growth was defined as ≥ 104 cfu/mL of E. coli. The last free-lying colony was saved.
56
3
57
Males self-collected rectal samples per protocol. An author (P.U.) collected vaginal and rectal
58
samples from FSPs. Swabs were streaked to modified Conradi-Drigalski agar, for overnight
59
incubation. The last three free-lying colonies on each plate, plus any morphologically distinct
60
colonies, were picked for analysis; this provides ≥ 97% sensitivity for detecting the
61
quantitatively predominant clone in rectal samples (23). Confirmed E. coli isolates were
62
stored in agar stabs (24).
63 64
Isolate characterization. E. coli isolates underwent O-typing or full O:K:H-serotyping at
65
Statens Serum Institute, Copenhagen, DK. One colony per O:K:H-serotype per specimen, and
66
colonies differing by O-type from the index FUTI isolate, underwent molecular typing,
67
including XbaI pulsed-field gel electrophoresis (PFGE) profiling (25). Pulsotypes (here
68
equated with strains) were assigned based on ≥ 94% profile similarity to index profiles within
69
a large PFGE database (26).
70 71
One representative per sample per PFGE type underwent PCR-based major phylogenetic
72
group determination (25). Extended virulence genotypes were determined by multiplex PCR
73
(27-29). Sequence type (ST) and clonal complex (CC; cluster of closely-related STs) was
74
determined by PCR (27), fumC-fimH sequence-analysis (30), and/or multi-locus sequence
75
typing (http://mlst.warwick.ac.uk).
76 77
Statistical methods. Comparisons of proportions and virulence score were tested using
78
Fisher's exact test and the Mann-Whitney U test, respectively, with significance set at P < .05.
79 80
Study population. The 10 index men with FUTI had a median age of 55 (range, 37–69) and a
81
median temperature of 39.3°C (range, 39.0–40.5) (Table S1). None affirmed anal intercourse
4
82
during the preceding 6 months. Two patients had voiding problems suggesting prostatism.
83
Only 3 had possible UTI-predisposing conditions: post-operative urethral catheterization 3
84
days pre-FUTI episode, diabetes mellitus, and a small bladder adenoma. The 10 FSPs' median
85
age was 48.5 years (range, 32–62). All denied UTI symptoms and antibiotic treatment in the
86
preceding three months.
87 88
Culture results. Culture surveillance was done once for 7 couples and repeatedly (over 1 to 22
89
months) for 3 couples. Of the 76 total rectal, vaginal, and urine cultures, 59 (78%) yielded E.
90
coli. Sequential serotyping and PFGE analysis resolved 23 unique E. coli strains (Figure 1),
91
which were predominantly from phylogroup B2 (12, 52%) and represented 15 CCs.
92
Seventeen (74%) qualified molecularly as ExPEC.
93 94
Strain sharing. Of the 23 strains, 6 occurred in both members of a particular couple, and only
95
in that couple (Figure 1). All 6 (100%) shared strains, vs. 4 (24%) non-shared strains,
96
represented the male's index FUTI isolate (P = .002) (Table 1). Shared strains also were more
97
likely to cause asymptomatic bacteriuria (ABU) or acute cystitis, and to colonize the woman's
98
rectum and/or vagina.
99 100
Longitudinal follow-up. During serial surveillance, in couples #10 and #29 the shared strains
101
caused sustained co-colonization and recurrent symptomatic UTI and/or ABU (Table S2-3).
102
In couple #95, at the time of the man's E. coli FUTI episode the FSP was colonized
103
extensively with the index E. coli strain, which 3 weeks later persisted in her despite being
104
undetectable in the man.
105
5
106
Characteristics of shared strains. Compared with non-shared strains, the 6 shared strains more
107
often represented phylogroup B2 and uropathogenic lineages CC73 or CC127, and more often
108
contained papG III, sfa/foc, sfaS, hlyD, cnf1, iroN, and malX (Table S4).
109 110
Comment. This in-depth microbiological survey of 10 men with E. coli FUTI and their
111
healthy FSPs identified frequent (60%) co-colonization of FSPs with the man's index E. coli
112
strain. This equals or exceeds the prevalence of such co-colonization among male partners of
113
women with E. coli cystitis (5, 11, 12).
114 115
Such strain sharing may result from person-to-person transmission or parallel acquisition. Co-
116
colonization between sex partners has been associated with specific sex practices (12). We
117
lacked data regarding sexual practices other than anal intercourse (which our subjects denied),
118
so cannot comment on behavioral correlates of co-colonization.
119 120
The potential clinical implications of co-colonization include risks of (i) acute UTI in a FSP
121
due to the male's UTI strain, and (ii) reintroduction of the strain into the index subject from a
122
co-colonized partner. The first scenario occurred here (couple #10). Whether decolonization
123
of co-colonized sex partners is warranted deserves study.
124 125
As in previous studies (6, 7, 12, 31), shared strains were distributed more broadly, caused
126
more infections, and exhibited more uropathogenic traits than non-shared strains. This
127
supports that certain E. coli traits and lineages promote both UTI pathogenesis and intestinal
128
colonization (32). Conceivably, interventions directed toward these traits and/or lineages
129
could prevent UTI by blocking both proceesses.
130
6
131
Since we investigated middle-aged male FUTI patients without serious medical or urological
132
compromise, and their middle-aged FSPs, our results cannot be extrapolated to other forms of
133
UTI or host populations. Additionally, since our rectal sampling method detects mainly
134
dominant fecal E. coli clones (23), we likely underestimated the true frequency of co-
135
colonization (33).
136 137
Summary. We demonstrated frequent sharing of the causative E. coli strain between men with
138
FUTI and their FSPs, which supports male UTI as sometimes being sexually transmitted.
139
Strain sharing was more common and extensive for classical urovirulent strains, suggesting
140
that "urovirulence" traits may also promote colonization and transmission.
141
7
142
ACKNOWLEDGMENTS
143 144
This material is based upon work supported by The Medical Society of Gothenburg, Sweden
145
(P.U.), and the Office of Research and Development, Medical Research Service, Department
146
of Veterans Affairs, USA (J.R.J.). The technical assistance of Susanne Jespersen, Statens
147
Serum Institute, Copenhagen, Denmark is highly appreciated.
148
8
149 150
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13
251
TABLE 1. Colonization and clinical characteristics of 23 Escherichia coli strains from 10
252
men with FUTIa and their female sexual partners in relation to strain sharing.
253 Prevalence of characteristic, no. (column %) Characteristic
Total
Non-shared
Shared
P value,
(n = 23)
strains
strains
non-
(n = 17)
(n = 6)
shared vs. sharedb
Male, any site
18 (78)
12 (71)
6 (100)
Rectum
11 (48)
10 (59)
1 (17)
FUTIa
10 (44)
4 (24)
6 (100)
.002
2 (9)
0 (0)
2 (33)
.06
11 (48)
5 (29)
6 (100)
.005
Rectum
10 (44)
5 (29)
5 (83)
.052
Vagina
4 (17)
0 (0)
4 (67)
.002
Acute cystitis during follow-up
1 (4)
0 (0)
1 (17)
ABU during follow-upc
2 (9)
0 (0)
2 (33)
ABU during follow-upc Female, any site
254 255
.06
a
FUTI, febrile urinary tract infection.
256
b
257
c
P values (by Fisher's exact test) are shown when P < .10.
ABU, asymptomatic bacteriuria. 14
258
FIG 1. Pulsed-field gel electrophoresis (PFGE) profiles of Escherichia coli isolates from
259
10 men with febrile urinary tract infection and their female sex partners. Dendrogram is
260
based on pairwise similarity relationships among XbaI PFGE profiles, as reflected in Dice
261
similarity coefficients. Colored rectangles enclose profiles of the same pulsotype. Labels to
262
right of dendrogram show the couple #. PFGE column lists pulsotype designation, which for
263
shared strains is shown also to the right of each rectangle. The red circle identifies the sole
264
instance of putative strain sharing across couples (couples 29 vs. 95), which likely was
265
spurious (based on differences in virulence genotype).
266
(Image on next page)
267
15
268
16
PFGExba 100
90
80
70
60
50
PFGExba
PFGE
Host Y
Sample
Symptoms
Sampling
1395
29 Female
Vaginal
Asymptomatic
4th
1395
29 Female
Urine
Cystitis
2nd
1395
29 Female
Urine
Asymptomatic
4th
1395
29 Female
Urine
Cystitis
5th
1395
29 Female
Fecal
Asymptomatic
4th
1395
29 Female
Vaginal
Asymptomatic
4th
1395
29 Female
Vaginal
Asymptomatic
4th
1395
29 Male
Urine
Asymptomatic
2nd
1395
29 Male
Urine
Asymptomatic
3rd
1395
29 Male
Urine
Febrile UTI
Initial
1395
29 Male
Fecal
Febrile UTI
Initial
1395
29 Female
Fecal
Cystitis
5th
1395
29 Male
Fecal
Asymptomatic
4th
1395
29 Male
Fecal
Asymptomatic
2nd
1399
125 Male
Urine
Febrile UTI
Initial
1399
125 Female
Fecal
Asymptomatic
Initial
1401
149 Male
Urine
Febrile UTI
Initial
634
149 Male
Fecal
Febrile UTI
Initial
1394
10 Male
Urine
Febrile UTI
3rd
1394
10 Male
Blood
Febrile UTI
4th
1394
10 Male
Urine
Febrile UTI
4th
1394
10 Male
Urine
Asymptomatic
2nd
1394
10 Female
Fecal
Asymptomatic
5th
1394
10 Female
Fecal
Asymptomatic
2nd
1394
10 Female
Vaginal
Asymptomatic
5th
1394
10 Female
Vaginal
Asymptomatic
2nd
1414
82 Female
Fecal
Asymptomatic
Initial
1099
10 Male
Fecal
Asymptomatic
5th
1373
103 Male
Urine
Febrile UTI
Initial
1373
103 Male
Fecal
Febrile UTI
Initial
1383
82 Male
Fecal
Febrile UTI
Initial
1383
82 Male
Urine
Febrile UTI
Initial
1398
121 Male
Urine
Febrile UTI
Initial
854
95 Male
Urine
Febrile UTI
Initial
854
95 Female
Vaginal
Asymptomatic
Initial
854
95 Female
Urine
Asymptomatic
2nd
854
95 Female
Urine
Asymptomatic
Initial
854
29 Female
Fecal
Cystitis
5th
854
95 Female
Fecal
Asymptomatic
Initial
1396
81 Male
Urine
Febrile UTI
Initial
1396
81 Female
Vaginal
Asymptomatic
Initial
1400
131 Male
Urine
Febrile UTI
Initial
1400
131 Female
Fecal
Asymptomatic
Initial
1411
103 Female
Fecal
Asymptomatic
Initial
1411
103 Female
Vaginal
Asymptomatic
Initial
1409
125 Male
Fecal
Febrile UTI
Initial
1405
121 Male
Fecal
Febrile UTI
Initial
1408
10 Male
Fecal
Febrile UTI
Initial
1406
121 Female
Vaginal
Asymptomatic
Initial
1406
121 Female
Fecal
Asymptomatic
Initial
1413
149 Female
Fecal
Asymptomatic
Initial
1407
131 Male
Fecal
Febrile UTI
Initial
762
81 Male
Fecal
Febrile UTI
Initial
1412
149 Male
Fecal
Febrile UTI
Initial
1395
1399
1394
854 1396 1400
