Simulation study for design of long counter for standard neutron fields from 1 keV to 20 MeV at NMIJ/AIST.

A De-Pangher-type long counter was designed for neutron measurements in standard neutron fields based on the results of simulations using the MCNP6 code at the National Metrology Institute of Japan, the National Institute of Advanced Industrial Science and Technology. The effects of six parameters in the design on the energy response of the long counter were investigated. The energy response was then quantitatively evaluated for eight design candidates selected from the investigation. The calculation results show that these candidates have a flatter energy response from 100 eV to 10 MeV compared to that of the current long counter. These candidates also reduce the difference between the average energy response from 10 eV to 1 MeV and that from 10 to 20 MeV.

Third nationwide surveillance of bacterial pathogens in patients with acute uncomplicated cystitis conducted by the Japanese surveillance committee during 2020 and 2021: Antimicrobial susceptibility of Escherichia coli, Klebsiella pneumoniae, and Staphylococcus saprophyticus.

The Japanese surveillance committee conducted a third nationwide surveillance of antimicrobial susceptibility of acute uncomplicated cystitis at 55 facilities throughout Japan between April 2020 and September 2021. In this surveillance, we investigated the susceptibility of Escherichia coli (E. coli), Klebsiella pneumoniae (K. pneumoniae), and Staphylococcus saprophyticus (S. saprophyticus) for various antimicrobial agents by isolating and culturing bacteria from urine samples. In total, 823 strains were isolated from 848 patients and 569 strains of target bacteria, including E. coli (n = 529, 92.9 %), K. pneumoniae (n = 28, 4.9 %), and S. saprophyticus (n = 12, 2.2 %) were isolated. The minimum inhibitory concentrations of 18 antibacterial agents were determined according to the Clinical and Laboratory Standards Institute manual. In premenopausal patients, there were 31 (10.5 %) and 20 (6.8 %) fluoroquinolone (FQ)-resistant E. coli and extended-spectrum ß-lactamase (ESBL)-producing E. coli, respectively. On the other hand, in postmenopausal patients, there were 75 (32.1 %) and 36 (15.4 %) FQ-resistant E. coli and ESBL-producing E. coli, respectively. The rate of FQ-resistant E. coli and ESBL-producing E. coli in post-menopausal women was higher than that for our previous nationwide surveillance (20.7 % and 32.1 %: p = 0.0004, 10.0 % and 15.4 %; p = 0.0259). For pre-menopausal women, there was no significant difference in the rate of FQ-resistant E. coli and ESBL-producing E. coli between this and previous reports, but the frequency of FQ-resistant E. coli and ESBL-producing E. coli exhibited a gradual increase. For appropriate antimicrobial agent selection and usage, it is essential for clinicians to be aware of the high rate of these antimicrobial-resistant bacteria in acute uncomplicated cystitis in Japan.

Standardization of Rn-222 concentration using the multi-electrode proportional counter.

Standardization of the concentration of gaseous 222Rn based on a multi-electrode proportional counter (MEPC) is under development as a primary standard in Japan. In this study, the concept and evaluation of its performance are reported. The latter consists of a preliminary result for the uncertainty budget associated with the measurement of the MEPC and compensation of the electric field distortion in the MEPC. Moreover, an ionization-chamber-based gas circulation system was added for the calibration of radon monitors in the air.

Detection of Neisseria gonorrhoeae or Chlamydia trachomatis from oral wash specimens using the Abbott RealTime CT/NG assay and the Cobas 4800 CT/NG assay: A prospective study.

INTRODUCTION: Isolating oropharyngeal Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) from oral wash specimens (OWSs) is uncommon. Therefore, we evaluated the performance of the Abbott RealTime CT/NG assay and the Cobas 4800 CT/NG assay in detecting NG and CT in OWSs. METHODS: This multicenter prospective study included 457 patients from 14 medical facilities suspected of having untreated male urethritis or female cervicitis from November 2014 to December 2015. OWSs were collected and tested using the Abbott and Cobas assays. Finally, the discordant results were confirmed using the APTIMA Combo 2 transcription-mediated amplification assay and retested using each assay. RESULTS: The sensitivity and specificity of the Abbott assay were 100% and 97.2% for NG and 87.5% and 100% for CT, respectively, and of the Cobas assay were 100% and 98.8% for NG and 93.8% and 99.8% for CT, respectively. Both assays had high negative but low positive predictive values for oropharyngeal NG (Abbott assay: 65.7%, Cobas assay: 82.1%). Based on the definition of "true positive," the prevalence of oropharyngeal NG and CT were 5.0% and 3.5%, respectively. CONCLUSIONS: The Abbott and Cobas assays using OWSs had high sensitivity and specificity, which can help diagnose oropharyngeal NG and CT. We consider that if a positive result is obtained, the patient should be treated because the negative predictive values were high. However, limited data are available on oropharyngeal NG and CT detection, and further studies are needed to clarify the role of oropharyngeal sexually transmitted infections.

SIMULATION OF NEUTRON RESPONSE FUNCTIONS OF SILICON SENSOR APPLIED TO REAL-TIME PERSONAL ALBEDO NEUTRON DOSEMETER IN THE ENERGY RANGE BETWEEN 0.01 EV AND 10 KEV.

Neutron response functions of a silicon sensor, which is applied to a new real-time personal albedo neutron dosemeter, have been simulated for low energy neutrons from 0.01 eV to 10 keV using the Monte Carlo technique. The angular neutron response functions were obtained by multiplying simulated neutron energy spectra crossing the neutron sensor and the cross-section of the 6Li(n,t)4He reaction. The neutron response functions have been closed to the dose conversion coefficient of personal doses, Hp(10) recommended by the International Commission on Radiological Protection by selecting neutrons incident from angles of 105° to 180° with respect to an axis perpendicular to an acrylic phantom surface. From these simulation results, the neutron energy response function has been improved by shielding the sensor with cadmium box without a face toward the phantom. The neutron sensor provides a good conformance to the Hp(10) conversion coefficients within 15% for low energy neutrons.

Development of a real-time neutron beam detector for boron neutron capture therapy using a thin silicon sensor.

We have developed a new real-time neutron detector, which is able to measure a direct neutron beam of boron neutron capture therapy. The detector consists of both a 40-µm-thick pn diode and around 0.09-µm-thick LiF neutron converter. Experimental results indicate that this neutron detector can measure neutron flux up to 1 × 109 (cm-2 s-1), separately from gamma rays around 500 mGy/h. The measured depth distribution of neutron flux in an acrylic block is in agreement with the activation results of gold.

Study of Normal Flora in the Pharynx of Healthy Children.

To improve our current understanding of normal flora in children, we investigated bacterial isolates from the pharynx and nasopharynx of 173 and 233 healthy children, respectively. The bacterial isolation rates were compared among three age groups: infants (<1 year), toddlers (1-5 years), and school-aged children (6-15 years). Gram-positive cocci were the predominant bacteria in the pharynx (Streptococcus mitis/oralis, 87.3%; Streptococcus salivarius, 54.3%; Rothia mucilaginosa, 41.6%; Staphylococcus aureus, 39.3%). Among infants, S. salivarius and Neisseria subflava, which are related to the development of teeth, were significantly lower than in the other age groups (P <0.0001, S. salivarius; P <0.01, N. subflava). With the exception of Corynebacterium pseudodiphtheriticum (44.2%, gram-positive rods), gram-negative rods largely predominated the nasopharynx (Moraxella catarrhalis, 32.1%; Moraxella nonliquefaciens, 28.3%). Among toddlers, M. catarrhalis and Streptococcus pneumoniae, which are the most common pathogens in acute otitis media, were significantly higher than in the infant group (P <0.05). Among the bacterial species implicated in pediatric respiratory infections, Streptococcus pyogenes was isolated in 3.5% of the pharyngeal samples. S. pneumoniae and Haemophilus influenzae were isolated in 22.3% and 17.2% of the nasopharyngeal samples, respectively. In conclusion, the normal flora of the respiratory tract differs not only by the sampling site but also by the age group.

Prevalence of xerostomia with or without overactive bladder symptoms.

Overactive bladder (OAB) occurs idiopathic or secondary to a neurological cause. In addition, OAB may also occur due to xerostomia, because it causes excessive drinking of water. If xerostomia is one of the causes of OAB, treating xerostomia may be effective. This study aimed to investigate the prevalence of xerostomia with or without overactive bladder symptoms. A web-based questionnaire was administered to investigate the prevalence of xerostomia with or without overactive bladder symptoms. The survey included questions concerning age, gender, medical history, medications, OAB symptoms by the Overactive Bladder Symptom Score (OABSS), and xerostomia by the Dry Mouth Scale (DMS). From the analysis, a total of 21 (13.0%) participants were identified as having OAB. The prevalence of xerostomia was six (28.6%) in the OAB group and 14 (10.0%) in the non-OAB group. OABSS and DMS were significantly higher in the OAB group than in the non-OAB group. Urgency score and urgency incontinence score of OABSS were substantially higher in xerostomia participants than non-xerostomia participants. The adjusted odds ratio of OAB showed DMS total score, xerostomia symptoms, accompanying symptoms, and other symptoms that were all significantly associated with OAB. These results suggested that OAB subjects, even untreated subjects, had xerostomia. It may be beneficial for clinicians to perform dry mouth management in parallel with careful choice pharmacotherapy for the wellness of OAB patients.

IMPROVEMENT OF GAMMA-RAY SUBTRACTION PROCEDURE FOR A CURRENT-MODE NEUTRON DETECTOR WITH A PAIR OF 6Li- AND 7Li-GLASS SCINTILLATORS.

A current-mode neutron detector with a pair of 6Li- and 7Li-glass scintillators has been developed to measure high-flux neutrons in a boron neutron capture therapy field. Neutrons are basically measured by subtracting gamma-ray component using current outputs from the 7Li-glass scintillator. In the present study, the difference in the gamma-ray sensitivity between the 6Li- and 7Li-glass scintillators and the neutron sensitivity for the 7Li-glass scintillator due to the 6Li contamination were also considered to improve the gamma-ray subtraction precision. The gamma-ray subtraction procedure was experimentally investigated in thermal neutron fields with 252Cf and 241Am-Be neutron sources, which have different gamma-ray intensities per unit neutron fluence. A linear relation between neutron fluence and current output was obtained for the neutron detector in the two types of thermal neutron fields with different gamma-ray intensities. It was found that the gamma-ray subtraction procedure is useful for current-mode neutron detectors.

Efficacy of Prophylactic Antimicrobial Administration of Tazobactam/Piperacillin for Radical Cystectomy with Urinary Diversion: A Multicenter Study.

OBJECTIVES: The purpose of this study was to investigate the association between prophylactic antibiotic administration (PAA) and postoperative infection after radical cystectomy with urinary diversion in patients with invasive bladder cancer. METHODS: Forty-nine consecutive cases were analyzed prospectively. Postoperative infections were categorized as surgical site infection (SSI) and remote infection (RI). We used the antibiotics tazobactam/piperacillin (TAZ/PIPC) as PAA (48 h). RESULTS: A total of 18 (36.7%) patients had postoperative infections, 4/18 (22.2%) patients had wound infections, and 12/18 (66.7%) patients had RI. In the risk factor study for SSI and RI occurrences, we found that the surgical time was significantly shorter in the non-infection group (p = 0.031). Taken together, these results suggest that TAZ/PIPC with shorter PAA duration (48 h) might lead to a lower rate of postoperative infections. CONCLUSIONS: Our data showed that PAA with TAZ/PIPC with a shorter duration PAA (48 h) might be recommended for RC with urinary diversion. We found that the surgical time was significantly shorter in the non-infection group. A prospective study based on our data is desirable to establish or revise PAA strategy for prophylactic medication to prevent postoperative infection after RC with urinary diversion.

Mutations in ParC and GyrA of moxifloxacin-resistant and susceptible Mycoplasma genitalium strains.

Macrolide or fluoroquinolone-resistant Mycoplasma genitalium is spreading worldwide. We aimed to determine the influence of single nucleotide polymorphisms (SNPs) in the quinolone resistance determining regions (QRDR) of parC and gyrA in cultured M. genitalium strains. In addition, we examined the prevalence of macrolide- and fluoroquinolone resistance mediating mutations in specimens collected from Japanese male patients with urethritis in two time-periods between 2005-2009 and 2010-2017, respectively, by sequencing the QRDR of parC and gyrA and domain V of the 23S rRNA gene. The minimum inhibitory concentrations (MIC) of moxifloxacin, sitafloxacin, ciprofloxacin, levofloxacin, doxycycline, minocycline, azithromycin and clarithromycin were determined in 23 M. genitalium strains. Three cultured strains had elevated MICs for moxifloxacin at 16, 4 and 2 mg/L and had SNPs with the amino-acid change Ser83→Ile in ParC (p<0.001) and 3 kinds of SNPs with amino-acid changes Asp99→Asn, Gly93→Cys and Met95→Ile in GyrA, respectively. Among a total of 148 M. genitalium positive urine specimens, the prevalence of A2058G and A2059G SNPs in the 23S rRNA gene and any SNPs in ParC increased from 4.8% and 22.6% in 2005-2009 to 42.2% and 53.1% in 2010-2017, respectively. If M. genitalium is considered multi-drug resistant in clinical specimens carrying SNPs in the 23S rRNA gene and Ser83→Ile in ParC, the prevalence of multi-drug resistance is 12.5% in 2010-2017 in Japan. In conclusion, the SNP resulting in Ser83→Ile in ParC is closely related to moxifloxacin resistance even though other factors may also affect treatment outcomes by moxifloxacin. The prevalence of circulating multi-drug resistant M. genitalium strains with macrolide- and fluoroquinolone-resistance is dramatically increasing in Japan.

[Validation of the Kit for Detecting Mycoplasma Genitalium from the Male Urethritis].

Mycoplasma genitalium is one of the pathogenic microorganisms in male urethritis as a sexually transmitted infection (STI). M.genitalium is detected in the urine specimens of 15-25% male patients with urethritis. The emergence of macrolide- or fluoroquinolone-resistant M.genitalium has become a serious problem in the treatment of male urethritis worldwide, but there is no commercial-based detecting kits accepted by the national insurance in Japan. In this study, we tested the validity of a molecular kit for detecting seven microorganisms related to STI (Anyplex™ II STI-7 Detection which detects Neisseria gonorrhoeae, Chlamydia trachomatis, M.genitalium, Mycoplasma hominis, Ureaplasma urealyticum, Ureaplasma parvum, Trichomonas vaginalis) produced by Seegene company in Korea. Seventeen M.genitalium strains were used to determine the detection limit of M.genitalium. M.genitalium DNA samples were extracted from M.genitalium strains and the diluted DNA samples were reacted to detect M.genitalium by the Anyplex™ II STI-7 Detection. The detection limit was determined as the maximum dilution of DNA samples and the number of M.genitalium DNA copies calculated. In this study, the minimum DNA copies to detect M.genitalium by the Anyplex™ II STI-7 Detection was determined to be around 50 per reaction. The detection rates of M.genitalium in urine specimens were compared between MgPa gene PCR and the Anyplex™ II STI-7 Detection. The positive and negative concordant rates were high as 96.4% (27/28) and 98.6% (71/72), respectively. The validity of the kit for detecting seven microorganisms related to STI (Anyplex™ II STI-7 Detection) was high and thought to be useful for clinical uses.

SIMULATED 8 MeV NEUTRON RESPONSE FUNCTIONS OF A THIN SILICON NEUTRON SENSOR.

Neutron response functions of a thin silicon neutron sensor are simulated using PHITS2 and MCNP6 codes for an 8 MeV neutron beam at angles of incidence of 0°, 30° and 60°. The contributions of alpha particles created from the 28Si(n,α)25Mg reaction and the silicon nuclei scattered elastically by neutrons in the silicon sensor have not been well reproduced using the MCNP6 code. The 8 MeV neutron response functions simulated using the PHITS2 code with an accurate event generator mode are in good agreement with experimental results and include the contributions of the alpha particles and silicon nuclei.

Summary of the UAA-AAUS guidelines for urinary tract infections.

Urinary tract infections, genital tract infections and sexually transmitted infections are the most prevalent infectious diseases, and the establishment of locally optimized guidelines is critical to provide appropriate treatment. The Urological Association of Asia has planned to develop the Asian guidelines for all urological fields, and the present urinary tract infections, genital tract infections and sexually transmitted infections guideline was the second project of the Urological Association of Asia guideline development, which was carried out by the Asian Association of Urinary Tract Infection and Sexually Transmitted Infection. The members have meticulously reviewed relevant references, retrieved via the PubMed and MEDLINE databases, published between 2009 through 2015. The information identified through the literature review of other resources was supplemented by the author. Levels of evidence and grades of recommendation for each management were made according to the relevant strategy. If the judgment was made on the basis of insufficient or inadequate evidence, the grade of recommendation was determined on the basis of committee discussions and resultant consensus statements. Here, we present a short English version of the original guideline, and overview its key clinical issues.

In Vitro Activity of Sitafloxacin and Additional Newer Generation Fluoroquinolones Against Ciprofloxacin-Resistant Neisseria gonorrhoeae Isolates.

Emergence of antimicrobial resistance in Neisseria gonorrhoeae is a major public health concern globally, and new antimicrobials for treatment of gonorrhea are imperative. In this study, the in vitro activity of sitafloxacin, a fluoroquinolone mainly used for respiratory tract or urogenital infections in Japan, and additional newer generation fluoroquinolones were determined against ciprofloxacin-resistant N. gonorrhoeae isolates. Minimum inhibitory concentrations (MICs) of ciprofloxacin, levofloxacin, moxifloxacin, sitafloxacin, pazufloxacin, and tosufloxacin against 47 N. gonorrhoeae isolates cultured in 2009 in Japan were determined by agar dilution method. The quinolone resistance-determining region (QRDR) of gyrA and parC was sequenced. The in vitro potency of sitafloxacin was substantially higher compared with all other tested fluoroquinolones. The MICs of sitafloxacin ranged from 0.03 to 0.5 mg/L for 35 ciprofloxacin-resistant N. gonorrhoeae isolates (ciprofloxacin MICs from 2 to 32 mg/L). No identified mutations in GyrA and ParC QRDR resulted in higher sitafloxacin MIC than 0.5 mg/L. Sitafloxacin had a high activity against N. gonorrhoeae isolates, including strains with mutations in DNA gyrase and topoisomerase IV, resulting in high-level resistance to ciprofloxacin and all other newer generation fluoroquinolones examined. However, it was still to a lower extent affected by GyrA and ParC QRDR mutations resulting in sitafloxacin MICs of up to 0.5 mg/L. This indicates that sitafloxacin should not be considered for empirical first-line monotherapy of gonorrhea. However, sitafloxacin could be valuable in a dual antimicrobial therapy and for cases with ceftriaxone resistance or allergy.

The detection of microorganisms related to urethritis from the oral cavity of male patients with urethritis.

OBJECTIVES: To investigate the presence of microorganisms related to urethritis in the oral cavity of male patients with urethritis and the efficacies of antimicrobials for urethritis on microorganisms in the oral cavity. METHODS: Ninety-two male patients with urethritis and 17 male controls participated to this study at 12 urology clinics in Japan between March 2014 and March 2015. The first voided urine (FVU) and oral wash fluid (OWF) specimens were collected from the participants. The microorganisms in both FVU and OWF specimens were detected by nucleic acid amplification tests at the first and follow-up visit. The efficacies of antimicrobials were evaluated after 1-4 weeks treatment completion. RESULTS: In a total of 92 male patients with urethritis, Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma hominis, Mycoplasma genitalium, Ureaplasma urealyticum, Ureaplasma parvum, Trichomonas vaginalis and Gardnerella vaginalis were detected from OWF specimens of 12%, 3%, 9%, 0%, 12%, 3%, 3% and 15% patients, respectively. From control males, no microorganism was detected from OWF specimens. Among 46 patients who could be evaluated for antimicrobial efficacies at the follow-up visit, 5 in FVU specimens failed by azithromycin (AZM), and 10 failed in OWF specimens (7 by AZM, 2 by tetracycline, 1 by spectinomycin; p = 0.002). Especially, a high prevalence of G. vaginalis remained positive after treatment for urethritis in the oral cavity. CONCLUSION: Microorganisms related to urethritis were detected in the oral cavity of male patients with urethritis. Antimicrobials that focused on urethritis, especially AZM regimen seem to be less effective for microorganisms in the oral cavity.

Neutron spectral fluence measurements using a Bonner sphere spectrometer in the development of the iBNCT accelerator-based neutron source.

The neutron spectral fluence of an accelerator-based neutron source facility for boron neutron capture therapy (BNCT) based on a proton linac and a beryllium target was evaluated by the unfolding method using a Bonner sphere spectrometer (BSS). A 3He-proportional-counter-based BSS was used with weak beam during the development of the facility. The measured epithermal neutron spectra were consistent with calculations. The epithermal neutron intensity at the beam port was estimated and the results gave a numerical target for the enhancement of the proton beam intensity and will be used as reference data for measurements performed after the completion of the facility.

Essential Japanese guidelines for the prevention of perioperative infections in the urological field: 2015 edition.

After publication of the initial version of the Japanese guidelines for urological surgery in 2007, new surgical techniques have been introduced. Furthermore, several important issues, such as criteria for use of single-dose antimicrobial prophylaxis and control of hospitalized infection, were also established, which led to alterations of the methods used for antimicrobial prophylaxis as well as perioperative management. The purpose of antimicrobial prophylaxis is to protect the surgical wound from contamination by normal bacterial flora. Antimicrobial prophylaxis should be based on penicillins with beta-lactamase inhibitors, or first- or second-generation cephalosporins, though penicillins without beta-lactamase inhibitors should not be prescribed because of the high prevalence of antimicrobial resistance. As an adequate intratissue concentration of the antimicrobial at the surgical site should be accomplished by the time of initiation of surgery, antimicrobial prophylaxis should be started up to 30 min before beginning the operation. Antimicrobial prophylaxis should be terminated within 24 h in clean and clean-contaminated surgery, and within 2 days of surgery using the bowels, because a longer duration is a risk factor for surgical site infection development. Importantly, possible risk factors for surgical site infections include the antimicrobial prophylaxis methodology used as well as others, such as duration of preoperative hospitalization, hand washing, the American Society of Anesthesiologists score, diabetes and smoking history. These guidelines are to be applied only for preoperatively non-infected low-risk patients. In cases with preoperative infection or bacteriuria that can cause a surgical site infection or urinary tract infection after surgery, patients must receive adequate preoperative treatment based on the individual situation.

Nationwide surveillance of the antimicrobial susceptibility of Chlamydia trachomatis from male urethritis in Japan.

Genital chlamydial infection is a principal sexually transmitted infection worldwide. Chlamydia trachomatis can cause male urethritis, acute epididymitis, cervicitis, and pelvic inflammatory disease as sexually transmitted infections. Fortunately, homotypic resistant C. trachomatis strains have not been isolated to date; however, several studies have reported the isolation of heterotypic resistant strains from patients. In this surveillance study, clinical urethral discharge specimens were collected from patients with urethritis in 51 hospitals and clinics in 2009 and 38 in 2012. Based on serial cultures, the minimum inhibitory concentration (MIC) could be determined for 19 isolates in 2009 and 39 in 2012. In 2009 and 2012, the MICs (MIC90) of ciprofloxacin, levofloxacin, tosufloxacin, sitafloxacin, doxycycline, minocycline, erythromycin, clarithromycin, and azithromycin were 2 µg/ml and 1 µg/ml, 0.5 µg/ml and 0.5 µg/ml, 0.125 µg/ml and 0.125 µg/ml, 0.063 µg/ml and 0.063 µg/ml, 0.125 µg/ml and 0.125 µg/ml, 0.125 µg/ml and 0.125 µg/ml, 0.016 µg/ml and 0.016 µg/ml, and 0.063 µg/ml and 0.063 µg/ml, respectively. In summary, this surveillance project did not identify any resistant strain against fluoroquinolone, tetracycline, or macrolide agents in Japan.

The first report: An analysis of bacterial flora of the first voided urine specimens of patients with male urethritis using the 16S ribosomal RNA gene-based clone library method.

OBJECTIVES: To analyse the bacterial flora of urine from patients with male urethritis using the clone library method. METHODS: Urine specimens from patients with urethritis were used. The bacterial flora was analysed according to the 16S ribosomal RNA gene-based clone library method. In addition, Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma urealyticum or Ureaplasma parvum were detected by the conventional PCR methods (TMA or real-time PCR) and data from the clone library and conventional PCR methods were compared. RESULTS: Among 58 urine specimens, 38 were successfully analysed using the clone library method. From the specimens, 2427 clones were evaluated and 95 bacterial phylotypes were detected. N. gonorrhoeae was detected from 6 specimens and as the predominant bacterial species in 5 specimens. M. genitalium was detected from 5 specimens and as the predominant bacterial species in 3 specimens. C. trachomatis was detected from 15 specimens using the TMA method, but was detected from only 1 specimen using the clone library method. U. parvum was detected from only 2 specimens using the clone library method. In addition, Haemophilus influenzae and Neisseria meningitidis were also detected in 8 and 1 specimens, respectively. Gardnerella vaginalis, which is a potential pathogen for bacterial vaginitis in women, was detected in 10 specimens. CONCLUSIONS: The clone library method can detect the occupancy rate of each bacteria species among the bacterial flora and may be a new method for bacterial analyses in male urethritis.