Bacterial Colonization and Histopathological Changes in Foreskin Tissue of Circumcised Children

Abstract

Background: The penile foreskin is a retractable fold of skin covering the glans and is rich in microbial flora. Circumcision, one of the most common pediatric procedures performed for cultural, religious, or medical reasons (such as pathological phimosis), removes this tissue and may alter local microbial colonization and infection risk. Post-operative wound infections remain a concern, with both Gram-positive and Gram-negative bacteria implicated This study aims to identify the bacterial species colonizing the foreskin of young children and to examine the histopathological effects of these microbes on foreskin tissue. Methods: Foreskin samples were collected from 49 boys (aged 1 day to 12 years) undergoing circumcision. Prior to excision, a sterile swab of the inner foreskin was taken and cultured on nutrient media to isolate bacteria. Isolates were identified using biochemical tests (e.g. catalase) and confirmed with an automated VITEK© system. Foreskin tissue specimens were fixed in 10% formalin, processed and embedded in paraffin, sectioned at 6 μm, and stained with hematoxylin and eosin (H&E) for histological examination. Results: Bacterial growth was obtained from 40/49 (81.6%) swabs. The most common isolates were Staphylococcus aureus (33%) and Escherichia coli (30%), followed by Klebsiella pneumoniae (15%), Pseudomonas aeruginosa (12%), and Proteus mirabilis (10%). Microscopic examination of the foreskin tissue revealed no significant age-related differences in baseline skin structure. However, samples with bacterial colonization showed notable inflammatory and degenerative changes. There was subepidermal inflammatory cell infiltration, vascular congestion, hemorrhage, and focal necrosis of the stratified squamous epithelium, along with fragmentation of the keratin layer and collagen fibers in the dermis. E. coli in particular was associated with intense dermal inflammation, edema, and accumulation of neutrophils, whereas other aerobes (e.g. S. aureus, P. mirabilis, K. pneumoniae) tended to cause milder superficial changes. These findings indicate that bacteria play a central role in post-circumcision tissue damage and inflammation. Conclusion: The foreskin of children is frequently colonized by potentially pathogenic bacteria, notably S. aureus and E. coli. Circumcision samples demonstrated histopathological evidence of inflammation and tissue injury associated with these microbes. Awareness of the common organisms and their effects on wound tissue can inform preventative strategies and prompt treatment to reduce post-circumcision infectious complications.