Marker Paper: The Urethral Microbiome of Adolescent Males
Authors: Fortenberry J. Dennis , Nelson David , Dong Qunfeng 
Published: November 2010

Project ID: 46317 – No publication moratorium.The microflora of the anterior male urethra during adolescence is poorly described and no data address the range of “typical” urethral organisms during adolescence as functions of pubertal development or onset of various types of partnered sexual activity. This means that current understanding of the urethral microbiome in adolescent men rests entirely on limited data inferred from adults, and from epidemiologic and behavioral explanations. Marked ethnic group variation in adolescent sexual behaviors and disparity in conditions such as sexually transmitted infections (STI) justifies exploration of potential ethnic group differences in the male urethral microbiome. Some research among adult males suggests important interactions between the male urethral microbiota and STI, but this research has not been extended to younger men.We will characterize the male urethral microbiome in longitudinal urine samples collected from a multi-ethnic cohort of adolescent males. The two specific aims of the project include Specific Aim 1. Describe the developmental urethral microbiome of adolescent males: Aim 1a. as a function of pubertal development; Aim 1b. as a function of racial/ethnic group; Aim 1c. as a function of oral-genital, vaginal, and anal sexual exposures; and, Aim 1d. as a function of circumcision status. Specific Aim 2. Describe variation in the urethral microbiome of adolescent males in the context of STI and identify organisms associated with acute and persistent non-specific urethritis: Aim 2a. to identify components of the microbiome associated with specific STI; Aim 2b. to compare the urethral microbiome of adolescent males who do and do not develop STI; and Aim 2c. to characterize microbial profiles associated with development of acute and persistent idiopathic urethritis.Microbial flora will be assessed as function of pubertal development, sexual activity, and incident STI. Subjects will be Latino (N=24), African-American (N=24), and Euro-American (N=24) males, ages 14 – 17 at enrollment; total N=72). Participants will be recruited from an urban community within an area of high prevalence of STI. Socio-demographic data will be collected at enrollment. Daily behavioral and symptomologic data will be collected via cell phone, which will also be used for cohort maintenance and scheduling of sample collections. Urine and penile coronal sulcus samples will be collected at enrollment and up to 36 1-month follow-up samples and selected contingent trigger samples triggered by specific symptoms and behaviors for characterization of microbiome using high-throughput 16s rRNA phylogeny, Q-PCR and metagenomic sequencing. STI testing by nucleic acid amplification will be done as well to better understand interactions between the urethral microbiome and infection. Cell phones also will be used to initiate alternate day sample collection for 14 days (7 samples) following trigger events such as specific sexual acts, antibiotic use, condom failure, or genital symptoms.