Gardnerella vaginalis in Symptomatic Men: Prevalence, Load, and Co-infections

Introduction Gardnerella vaginalis, traditionally linked to bacterial vaginosis (BV) in women, is increasingly detected in men with urethral symptoms. Its clinical relevance and co-infection patterns remain poorly defined. This study assessed the prevalence, quantitative load, and co-infections of G. vaginalis, and other urogenital pathogens in symptomatic men. Methods We retrospectively analyzed 418 symptomatic male patients using multiplex polymerase chain reaction (PCR), targeting 21 pathogens. Pathogen loads were reported as qualitative or quantitative (<10⁴ or ≥10⁴ copies/mL). Results At least one pathogen was detected in 239 (57.2%) patients (95% CI: 52.4-61.9). G. vaginalis was most frequently identified: 90 (21.5%), followed by Chlamydia trachomatis: 63 (15.1%), Mycoplasma genitalium: 45 (10.8%), and Ureaplasma urealyticum: 38 (9.1%). Quantitative analysis showed 105 patients with G. vaginalis <10⁴ copies/mL and 90 with ≥10⁴ copies/mL. Polymicrobial infections occurred in 81 (19.5%) patients, most often involving G. vaginalis with U. urealyticum (n = 13) or U. parvum (n = 11). Conclusions G. vaginalis was the leading pathogen in symptomatic men, frequently present at clinically significant loads and in co-infections. These findings support its inclusion in routine male sexually transmitted infection (STI) diagnostic panels.