Sexual Transmission of Enterobacter and Staphylococcus epidermidis
Enterobacter aerogenes, Enterobacter cloacae, and Staphylococcus epidermidis are NOT considered sexually transmitted pathogens and do not pass through typical sexual contact.
Evidence from STD Guidelines
The CDC sexually transmitted disease treatment guidelines from both 1993 and 1998 provide comprehensive lists of sexually transmitted enteric pathogens, and notably none of these organisms appear on those lists 1.
Recognized Sexually Transmitted Pathogens
According to CDC guidelines, the actual sexually transmitted gastrointestinal pathogens include 1:
For Proctitis (rectal inflammation):
- Neisseria gonorrhoeae
- Chlamydia trachomatis (including LGV serovars)
- Treponema pallidum (syphilis)
- Herpes simplex virus (HSV)
For Proctocolitis (rectal and colonic inflammation):
- Campylobacter species
- Shigella species
- Entamoeba histolytica
- Rarely, C. trachomatis (LGV serovars)
For Enteritis (intestinal inflammation via oral-fecal contact):
- Giardia lamblia (most common in healthy patients)
- Various opportunistic pathogens in HIV-infected patients
Nature of These Organisms
Enterobacter Species
Enterobacter aerogenes (now reclassified as Klebsiella aerogenes) and Enterobacter cloacae are hospital-acquired opportunistic pathogens, not sexually transmitted organisms 2, 3.
- These bacteria cause nosocomial (hospital-acquired) infections, particularly bloodstream infections in patients with invasive devices, immunosuppression, or prior antibiotic exposure 3, 4
- They are environmental bacteria that colonize hospital settings and exploit vulnerable hosts 2
- Transmission occurs through healthcare-associated routes (contaminated equipment, healthcare worker hands), not sexual contact 2
Staphylococcus epidermidis
Staphylococcus epidermidis is a normal skin commensal organism that becomes pathogenic primarily in the context of indwelling medical devices (catheters, prosthetic joints, cardiac devices). It is not transmitted sexually and is already present on virtually everyone's skin as part of normal flora.
Clinical Context
If these organisms are isolated from genital or urinary specimens, consider 3, 4:
- Urinary tract infection from instrumentation or catheterization (not sexual transmission)
- Contamination during specimen collection
- Opportunistic infection in immunocompromised patients
- Healthcare-associated infection in hospitalized patients
The presence of these organisms should prompt evaluation for underlying medical conditions, recent healthcare exposures, or indwelling devices rather than sexual transmission 3.