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Exploring the Bacterial Diversity of the Male Urethra During EXPLORING THE BACTERIAL DIVERSITY OF THE MALE URETHRA DURING IDIOPATHIC URETHRITIS Rowan Micah Farrell Submitted to the faculty of the University Graduate School in partial fulfillment of the requirements for the degree Master of Science in the Department of Microbiology and Immunology, Indiana University August 2020 Accepted by the Graduate Faculty of Indiana University, in partial fulfillment of the requirements for the degree of Master of Science. Master's Thesis Committee ______________________________________ David E. Nelson, PhD, Chair ______________________________________ Margaret Bauer, PhD ______________________________________ Stanley Spinola, MD ii © 2020 Rowan Micah Farrell iii DEDICATION To my mentor Dave Nelson and my friends in the Nelson Laboratory. It has been a privilege to learn from you and work with you over the past two years. To my dear friend Arka. Thank you for getting me through the past two years with my sanity intact. To my family. Thank you for all the love and support. To my mother Erin. Thank you for everything. iv ACKNOWLEDGEMENT I would like to express my sincere gratitude to my committee members, Dr. Spinola and Dr. Bauer, for their encouragement and guidance over the course of my time in the MS program. I also thank Dr. Stephen Jordan, Lora Fortenberry, Lisa Coss, the IU School of Medicine Infectious Disease Laboratory, and the staff of the Bell Flower Clinic for their critical work on and around this study. v Rowan Micah Farrell EXPLORING THE BACTERIAL DIVERSITY OF THE MALE URETHRA DURING IDIOPATHIC URETHRITIS Idiopathic urethritis (IU) comprises up to 50% of symptomatic cases of male urethritis in clinical settings. The syndrome is of an unknown etiology but may be due to an as yet unidentified bacterial pathogen(s). We were interested in identifying pathogens that could cause IU using multiple methods. Shotgun metagenomic sequencing or 16S rRNA sequencing methods can provide rich datasets but are limited by the completeness of the corresponding sequence reference databases. We generated metagenomic and 16S datasets from DNA extracted from urethral swabs of men with IU to determine the composition of their urethral microbiome. In order to enrich the corresponding reference databases used to identify the reads in the sequence datasets, I cultivated bacteria from the first void urine (FVU) of men with IU. My goal was to grow and whole genome sequence bacterial isolates that are not currently represented in the reference databases. Of the 216 men we enrolled at the Bell Flower STD clinic in Indianapolis, IN, 59 men had IU. I grew a total of 802 isolates from the FVU of the IU patients and identified those isolates using colony-based 16S rRNA PCR. Based on % sequence similarity to the nearest type strain, I sorted the 16S alleles into four categories: Species (≥98 % identity) (N=264), Genus (≥95 % identity) (N=407), Closest Match (<95 % identity) (N=95), and No Hit (0 % identity) (N=22). There were 24 genera represented in the isolate collection. Of these, the six most abundant genera were Streptococcus, Staphylococcus, Corynebacterium, Haemophilus, Gardnerella, and Prevotella. These six genera composed nearly 80% of all IU-associated isolates. All sequences below 98% sequence vi similarity represent potentially novel strains of bacteria. We will proceed with whole genome sequencing of bacterial isolates with the goal of improving genome database coverage of bacterial diversity in the male urethra. David E. Nelson, PhD, Chair vii TABLE OF CONTENTS List of Tables .......................................................................................................................x List of Figures .................................................................................................................... xi List of Abbreviations ....................................................................................................... xii Introduction ..........................................................................................................................1 1.1 Male Urethritis .........................................................................................................1 1.2 Demographic Characterization of IU .......................................................................4 1.3 Potential Etiologies of IU.........................................................................................6 1.4 Capturing Bacterial Diversity in the Urethra ...........................................................6 1.5 Research Objectives .................................................................................................9 Methods and Materials .......................................................................................................11 2.1 Study Design ..........................................................................................................11 2.2 Five Pathogen Testing............................................................................................12 2.3 Culture Methods.....................................................................................................12 2.4 rRNA 16S Allele PCR and Isolate Identification ..................................................13 2.5 Multiplex Clade PCR .............................................................................................16 Results ................................................................................................................................18 3.1 NGU Case Demographics ......................................................................................18 3.2 The IUMP Isolate Collection .................................................................................21 3.3 Multiplex Clade PCR for Gardnerella Isolates .....................................................32 3.4 Novel Bacterial Strains ..........................................................................................34 Discussion ..........................................................................................................................35 viii References ..........................................................................................................................39 Curriculum Vitae ix LIST OF TABLES Table 1. 16S rRNA Primers ...............................................................................................13 Table 2. Multiplex Primers ................................................................................................17 Table 3. Demographics ......................................................................................................20 Table 4. Multiplex PCR Results ........................................................................................33 x LIST OF FIGURES Figure 1. Strain Sequencing and Identification Workflow ................................................15 Figure 2. Etiology by Percent ............................................................................................18 Figure 3. Categorization of Isolates by Percent Sequence Similarity ................................22 Figure 4. Descriptive Statistics for the Strain Collection ..................................................24 Figure 5. Number of Isolates with ≥ 95% Sequence Similarity by Genus ........................25 Figure 6. Top 10 Most Common Genera ...........................................................................26 Figure 7. Streptococcus Isolates ........................................................................................27 Figure 8. Staphylococcus Isolates ......................................................................................28 Figure 9. Corynebacterium Isolates ...................................................................................29 Figure 10. Prevotella Isolates ............................................................................................30 Figure 11. Haemophilus Isolates ........................................................................................31 Figure 12. Gardnerella Isolates .........................................................................................32 Figure 13. Isolates with <95% Sequence Similarity, by % Sequence Similarity ..............34 xi LIST OF ABBREVIATIONS CT – Chlamydia trachomatis HSV – Herpes Simplex Virus IU – Idiopathic Urethritis MG – Mycoplasma genitalium NAAT – Nucleic Acid Amplification Test NG – Neisseria gonorrhoeae NGU – Nongonococcal Urethritis PMNLs – Polymorphonuclear Leukocytes rRNA – Ribosomal Ribonucleic Acid UU – Ureaplasma urealyticum TV – Trichomonas vaginalis xii Introduction 1.1 Male Urethritis Male urethritis is an inflammatory syndrome of the male urethra. The urethra in men is the long, narrow tube that carries semen from the ejaculatory ducts and urine from the bladder through the length of the penis as they exit the body. The urethra can become inflamed when it is irritated or infected, causing the affected individual significant discomfort. Male urethritis is the most frequently diagnosed condition of the male urogenital tract and accounts for well over two million medical visits per year in the United States. [2] There are multiple infectious etiologies of male urethritis, the majority of which are sexually transmitted infections (STI) that can bear significant risk for sexual partners of urethritis patients. The risks to sexual partners of men with urethritis include severe complications of cervicitis or rectal infections and an increased risk of HIV acquisition.
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