Chlamydia trachomatis Infection Is Related to Poor Semen Quality in Young Prostatitis Patients

doi:10.1016/j.eururo.2009.05.015

European Urology

Volume 57, Issue 4, April 2010, Pages 708-714

https://doi.org/10.1016/j.eururo.2009.05.015 Get rights and content

Abstract

Background

The impact of chronic prostatitis resulting from Chlamydia trachomatis infection on male fertility is controversial.

Objective

To investigate the correlation between C. trachomatis infection and semen quality in young male patients affected by chronic prostatitis resulting from C. trachomatis infection and to evaluate the correlation between anti–C. trachomatis immunoglobulin (Ig) A against heat shock protein 60 (HSP60), heat shock protein 70 (HSP70), and semen parameters.

Design, setting, and participants

All patients with clinical and instrumental diagnosis of chronic prostatitis underwent microbiological cultures for common bacteria, DNA extraction, mucosal and serum antibody evaluation for C. trachomatis, and semen parameter analysis. Western blot analysis of mucosal anti–C. trachomatis IgA was performed.

Interventions

Subjects were split into two groups: Group A consisted of patients with chronic prostatitis resulting from common bacteria (uropathogens), and group B consisted of patients with chronic prostatitis resulting from C. trachomatis infection.

Measurements

The relationship between C. trachomatis infection and semen parameters as well as the correlation among IgA levels, IgA characterisation, and semen analysis were determined.

Results and limitations

We enrolled 1161 patients (mean age: 36.5 yr). Of these, 707 patients were placed in group A, and 454 were placed in group B. Significant statistical differences were reported between groups in terms of sperm concentration (p < 0.001), percentage of motile sperm (p < 0.001), and normal morphologic forms (p < 0.001). Strong correlations between mucosal anti–C. trachomatis IgA and sperm concentration (p < 0.001) and normal morphologic forms (p < 0.001) were reported. Correlations among positivity to HSP60, HSP70, and sperm concentration (p < 0.003) and normal morphologic forms (p < 0.001) were also reported.

Conclusions

This study demonstrated the role of chronic prostatitis resulting from C. trachomatis in male fertility decrease, highlighting probable immunomediated damage to germinal cells because of C. trachomatis infections.

Introduction

Chronic prostatitis has been established as an important socioeconomic problem [1]. In a recent report, we found an overall prevalence of chronic prostatitis in urologic outpatients in Italy of 13.7%, showing that this syndrome is particularly present in young males (mean age: 34.9 yr) [2]. In contrast, recent reports have established that Chlamydia trachomatis causes symptomatic infection in the lower male genital tract, which should have a potential role in chronic prostatitis pathogenesis [3]. The role of C. trachomatis in everyday clinical practice is now on the increase because C. trachomatis infections are the most prevalent sexually transmitted bacterial infections worldwide [3].

Chronic prostatitis resulting from C. trachomatis infection is not only a cause of quality-of-life decrease [4] but also seems to have a significant impact on couples’ reproductive health [5]. Even if the role of C. trachomatis infections in female fertility deterioration is well demonstrated [6], the role of C. trachomatis infections of the upper male genital tract as a probable aetiologic factor for male infertility has been fully argued without any convincing demonstration of a clear correlation [7]. Moreover, the pathophysiology of C. trachomatis infection damage on human fertility is also unclear for the moment. However, Eley and coworkers recently showed that C. trachomatis could directly damage male sperm [8], and Erbengi has already showed the entry of the elementary body (EB) into the human spermatozoon head, demonstrating that C. trachomatis not only adhered to but also penetrated the spermatozoon tail structure [9].

The presence of anti–C. trachomatis immunoglobulin (Ig) A in semen from males with previous contact with C. trachomatis is associated with elevated levels of γδ T lymphocytes [10] that also correlate with the presence of antisperm antibodies [11]. The crucial point in the pathophysiology pathway of male infertility resulting from C. trachomatis infections should therefore be indicated in the development of high levels of mucosal antibodies against high-molecular-weight proteins, especially major outer membrane protein 2 (MOMP2), heat shock protein 60 (HSP60), and heat shock protein 70 (HSP70) [12]. Moreover, the prevalence of serum IgA antibodies to HSP60 has been found to be significantly higher in the female partners of subfertile couples than in their fertile controls [13], suggesting that an autoimmune response to human HSP60 can develop following C. trachomatis female genital tract infection, probably as a consequence of an immune response to an epitope of chlamydial HSP60 crossreactive with the human HSP60 [14].

Nevertheless, the probable association between IgA antibodies to HSP60 and abnormal semen parameter analysis has not been clarified, and the reported results are very dissimilar. Several authors have stated that there is no relationship between IgA antibodies and the sperm variables or leukocyte count in semen [15], suggesting that IgA antibodies to C. trachomatis do not cause alterations in sperm function and are not associated with inflammatory response. Others have reported that C. trachomatis infections of male sexual glands might cause severe complications that could threaten male fertility [16]. The primary aim of this study was to investigate the correlation between C. trachomatis infection and semen quality in a large cohort of young male patients affected by bacterial chronic prostatitis resulting from C. trachomatis infection. The secondary aim was to investigate the correlation between anti–C. trachomatis mucosal IgA levels and semen parameters. Finally, the third aim was to evaluate the correlation between anti–C. trachomatis IgA against HSP60, HSP70, and semen parameters.

Section snippets

Study design

All consecutive patients with clinical and instrumental diagnosis of chronic prostatitis attending the same Sexually Transmitted Disease (STD) Centre from May 2001 to May 2002 were eligible for this study. Inclusion criteria were the presence of bacterial chronic prostatitis with symptoms for >6 mo. Bacterial chronic prostatitis (National Institutes of Health [NIH] classification, class 2) diagnosis was carried out in accordance with European Association of Urology (EAU) guidelines [17]. Data

Results

From a total population of 3560 consecutive patients attending our STD Centre and reporting clinical and instrumental diagnosis of chronic prostatitis, 1228 consecutive patients who had positives cultures were considered for the study. Sixty-seven patients were excluded for lack of data collection. Finally, 1161 patients (mean age: 36.5 yr; range: 18–44) were enrolled. All patients attended our STD Centre and came from all of the Italian regions. All anamnestic and clinical data at enrolment

Discussion

Even if the role of C. trachomatis infection in the development of urethritis and epididymitis is now well accepted in the literature, its role in the development of prostatitis and male infertility remains controversial [16]. Occasionally, these microorganisms cause symptomatic prostatovesiculitis with deterioration of semen quality by an excess of reactive oxygen species formation or by inducing immunologic responses [22]. Indeed, the role of C. trachomatis in male infertility is highly

Conclusions

We have demonstrated an association between a decrease in male fertility and local mucosal immunity to C. trachomatis, highlighting the need for future studies designed to establish the necessity for C. trachomatis infection screening in asymptomatic males of subfertile couples.

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Infections and male infertility
2023, Progres en Urologie
Le rôle des infections urogénitales dans l’infertilité masculine fait depuis longtemps l’objet d’un débat.
Une recherche bibliographique limitée à la littérature en anglais chez l’homme publiée avant 5/2023 a permis après analyse de sélectionner 189 articles.
L’infertilité masculine est souvent d’étiologie multifactorielle, et il est important pour optimiser le pronostic de prendre en charge tous les facteurs correctibles, dont les causes infectieuses, qui représentent l’une des plus fréquentes étiologies. Les agents infectieux en cause dans les infections urogénitales sont le plus souvent bactériens ou viraux, plus rarement parasitaires. Ils peuvent infecter les voies séminales, les glandes accessoires masculines et/ou les testicules et aboutissent le plus souvent à une inflammation et à une augmentation du stress oxydant. Ces infections diminuent la fertilité masculine, notamment en altérant les paramètres du spermogramme et en augmentant la fragmentation de l’ADN du spermatozoïde. Pour ces raisons, la recherche d’une infection urogénitale doit être systématique avec anamnèse et examen clinique minutieux, échographie et examens bactériologiques systématiques et orientés par la clinique. Un traitement étiologique pourra être proposé en fonction du tableau et du germe en cause.
Cette revue devrait aider l’urologue à établir un diagnostic précis de la forme et de l’extension de l’infection, et lui permettre de définir une stratégie thérapeutique appropriée, adaptée au patient, afin d’obtenir les meilleures chances d’amélioration de la fertilité masculine.
The role of urogenital infections in male infertility has long been the subject of debate.
A bibliographic search limited to English-language literature on human subjects published before 5/2023 resulted in the selection of 189 articles.
Male infertility is often of multifactorial aetiology, and to optimise the prognosis it is important to manage all the factors that can be corrected, including infectious causes, which represent one of the most frequent aetiologies. The infectious agents involved in urogenital infections are most often bacterial or viral, and more rarely parasitic. They can infect the seminal tract, male accessory glands and/or testicles, and usually result in inflammation and increased oxidative stress. These infections reduce male fertility, in particular by altering spermogram parameters and increasing sperm DNA fragmentation. For these reasons, the search for a urogenital infection should be systematic, involving a careful history and clinical examination, ultrasound and systematic bacteriological tests guided by clinical findings. Aetiological treatment may be proposed depending on the picture and the germ involved.
This review should help the urologist to establish an accurate diagnosis of the form and extent of the infection, and enable him to define an appropriate therapeutic strategy, tailored to the patient, in order to obtain the best chances of improving male fertility.
Bacterial infection of the male reproductive system causing infertility
2020, Journal of Reproductive Immunology
Bacterial infections play a disruptive and hidden role in male reproductive failure. Different kinds of bacteria are often able to interfere with reproductive function in both sexes and lead to infertility. In this study, to further evaluate the role of bacterial infections in male reproduction we provided an extensive overview of so far researches investigating the effects of bacterial infections on male fertility. We searched Medline, PubMed, Scopus and Google scholar databases to identify the potentially relevant studies on bacterial infections and their implications in male infertility. All the bacteria included in this article have negative effects on the male reproductive function; however, there is ample evidence to blame bacteria such as Escherichia coli, Chlamydia trachomatis, Ureaplasma, Mycoplasma and Staphylococcus aureus for reduced fertility and deterioration of sperm parameters. More studies are needed to clarify the molecular mechanisms by which different bacteria exert their detrimental effects on male reproductive system. Getting more insight into probable mechanisms, would significantly facilitate the production of new, advanced, and effective remedies in the future. In view of all evidence, we strongly suggest increasing awareness among people and considering screening programs for patients seeking fertility both to avoid transmission and to improve fertility outcomes among them.
Heat SHOCK proteins in equine spermatozoa: Expression and correlation to kinetic and environmental parameters
2020, Theriogenology
Citation Excerpt :
Recently a critical role of these proteins in modulating male fertility has emerged [8–10]. They are also involved in the events related to pathogens-induced infertility, because pathogens damaging HSPs expressed on spermatozoa also impair fertility [11]. On the other hand, the prominent role of these chaperones is protecting any cells from the deleterious effects of temperature increase.
Heat Shock Proteins are chaperones primary involved in the repair of cellular damages induced by temperature. The harmful effect of temperature on the male gonad is well known, on the contrary knowledge on the effects of the environment on semen quality are still insufficient. The aim of this paper was to learn more about the role of HSPs and the environment in modulating the physiology of equine male gonads. We showed a detailed analysis of equine semen characteristic and the expression level of three HSPs (60-70-90) over a one-year period analyzing the effects of temperature and humidity and the correlation among the different variables. We showed also that the interpretation of results depends strongly on the way in which data are assembled and analyzed, therefore we compared results obtained from three different ways of grouping: according to single months, to weather seasons and to mare reproductive periods. Results showed that the expression of the three HSPs is correlated to the environment through temperature and humidity and that it reaches the highest level in the breeding season and in summer. We found also that HSPs expression is correlated to some variables describing the quality of equine semen (concentration) and the kinetic of spermatozoa (total motility-MOT, %, average path velocity -VAP, μm/s- and lateral head displacement -ALH, μm). No correlation was found between HSPs expression and the mitochondrial membrane potential; while viability and HSP90 expression resulted positively correlated. The month-by-month analysis evidenced that in February equine semen has the highest kinetic characteristics (increased linearity –LIN, %-, straightness –STR, % -and average path velocity -VAP, μm/s) with the highest number of motile, progressive motile and rapid cells.
These results may have a great impact in the comprehension of functional aspects of the physiology of equine semen and may have potential implications for breeders who want to understand the period (and/or month) of the year in which equine semen reaches the best characteristics with increased chances for better results in reproductive practice.
Effects of bacteria on male fertility: Spermatogenesis and sperm function
2020, Life Sciences
Bacterial infection can negatively affect different parts of the male genital tract and subsequently cause impaired spermatogenesis and male fertility. However, most of the previous studies have focused on the infected organs of the male genital tract and there are not many studies that investigated the direct effect of bacteria on sperm and their mechanism of action. Interestingly, bacteria can induce different damages on sperm cells such as DNA fragmentation, cell membrane peroxidation, and acrosome impairment. Such negative effects can be mediated by bacteria-secreted toxins and metabolites or by direct attachment of bacteria on the sperm cells and subsequent activation of signaling pathways related to oxidative stress, apoptosis, and inflammation. These bacteria-induced changes can impair semen parameters and subsequently cause infertility. Given the significant destructive effect of some bacteria on sperm function and male fertility, in this study, we reviewed the impact of male urogenital bacteria on spermatogenesis and sperm functions as well as the underlying mechanisms by which the bacteria can damage sperm.
Prevalence and role of IgG anti-Chlamydia trachomatis in a population of infertile men in Morocco
2019, Progres en Urologie
L’infertilité est un problème mondial de santé publique qui affecte 15 % des couples en âge de procréer. L’infertilité masculine est en cause dans 20 à 50 % des cas. Ces chiffres sont en nette augmentation de par le monde. Plusieurs facteurs peuvent être responsables de cette infertilité avec en particulier les facteurs hormonaux, génétiques, toxiques ou infectieux. Ces derniers sont dominés principalement par l’infection à Chlamydia. Parmi les complications les plus graves de cette infection, on retrouve les troubles de fertilité liés à l’urétrite, l’épididymite et à l’azoospermie totale irréversible chez l’homme et les obstructions tubaires et les grossesses extra-utérines chez la femme.
Déterminer la prévalence des IgG anti-Chlamydia trachomatis chez les hommes consultant pour infertilité et analyser l’association entre le contact antérieur avec cette bactérie et l’altération de la qualité du sperme et la fonction des spermatozoïdes.
Étude prospective sur 26 mois de 143 patients adressés au service pour bilan d’infertilité du couple. Les données démographiques, le caractère primaire ou secondaire de l’infertilité, les facteurs de risque (tabac, hernie inguinale, varicocèle et antécédents d’infections urogénitales), les paramètres spermatiques (volume, mobilité, PH, vitalité et anomalies morphologiques) ont été étudiés ainsi que la détermination du titre des IgG anti-C. trachomatis. La prévalence de l’infection à Chlamydia ainsi que son impact sur les différents paramètres du spermogramme ont été analysés.
L’âge moyen des patients était de 38,5 ± 8,55 ans. L’infertilité était primaire chez 72 % des patients. Parmi les patients, 54,5 % avaient un spermogramme anormal. Une sérologie Chlamydia était positive chez 37,1 % des patients dont 58,5 % avaient un spermogramme anormal. L’analyse des différents paramètres spermatiques chez les patients Chlamydia positive et Chlamydia négative retrouve une altération significative de la vitalité dans le groupe Chlamydia positive avec un OR à 2,41, p = 0,02, (IC95 % : 1,15–5,06).
La prévalence de l’infection à Chlamydia est élevée chez les hommes infertiles. Les IgG anti-Chlamydia seraient associés à une altération de la vitalité des spermatozoïdes sans altération significative des autres paramètres spermatiques.
3.
Infertility is a global public health problem that affects 15% of couples of childbearing age. Male infertility is involved in 20 to 50% of cases. These figures are sharply increasing around the world. Several factors may be responsible for this infertility with especially hormonal, genetic, toxic or infectious factors. The latter are dominated mainly by Chlamydia infection. Among the most serious complications of this infection are infertility related to urethritis, epididymitis and irreversible total azoospermia in men and tubal obstructions and ectopic pregnancies in women.
To determine the prevalence of IgG anti-Chlamydia trachomatis in men consulting for infertility and the association between previous contact with this bacterium and the impairment of sperm quality and sperm function.
Prospective study over 26 months of 143 patients referred to the service for infertility assessment of the couple. Demographic data, primary or secondary character of infertility, risk factors (tobacco, inguinal hernia, varicocele and history of urogenital infections), semen parameters (volume, mobility, pH, vitality and morphological abnormalities) were studied as well as the determination of the anti-C. trachomatis IgG titer. The prevalence of Chlamydia infection and the association of the infection and alteration of the various parameters of the semen were analyzed.
The average age of patients was 38.5 ± 8.55. Infertility was primary in 72% of patients. Among the patients, 54.5% had an abnormal spermogram. Chlamydia IgG antibodies were positive in 37.1% of patients whose 58.5% had abnormal spermogram. Analysis of sperm parameters of patients with and without IgG C. trachomatis showed an altered vitality in Chlamydia positive patients with an OR at 2.41, P = 0.02, (95% CI: 1.15–5.06).
The prevalence of Chlamydia infection is high in infertile male. C. trachomatis IgG antibodies may be associated with an alteration of spermatozoa vitality without significant impairment of other semen parameters.
3.
Bacteriospermia: Effects on semen parameters
2018, Gynecologie Obstetrique Fertilite et Senologie
La bactériospermie peut être à l’origine d’une hypofertilité masculine. En effet, 60 % des patients traités en assistance médicale à la procréation, ont présenté une infection locale ou une inflammation du tractus génital masculin. Les effets directs de la bactériospermie sur les paramètres spermatiques demeurent un sujet controversé. On se propose d’étudier l’impact de la bactériospermie sur les paramètres spermatiques chez les patients consultant pour infertilité.
Il s’agissait d’une étude rétrospective comparative intéressant deux groupes : un groupe de 70 patients présentant une bactériospermie (groupe 1) et un groupe témoin de 70 patients sans bactériospermie (groupe 2). Pour ces différents groupes nous avons étudié les paramètres spermatiques standards à savoir le volume et la viscosité séminale, la numération, la mobilité initiale et secondaire, la vitalité et la morphologie des spermatozoïdes. La comparaison de ces différents paramètres à été réalisés par le test Chi² et le test de Fisher.
L’âge moyen de notre population était de 40,4 ans ± 6,7. Il n’y avait pas de différence significative entre les volumes moyens de l’éjaculat des 2 groupes (groupe 2 : 2,78 mL versus groupe 1 : 2,92 mL avec p = 0,2). Également pour la viscosité, aucune différence n’a été notée (p = 0,68). Les paramètres altérés en présence de la bactériospermie étaient la concentration moyenne et la mobilité des spermatozoïdes (p = 0,001 et p = 0,049 respectivement). Également la prévalence de l’asthénospermie secondaire était plus élevée en présence d’une bactérospermie (p = 0,006). Aucune différence statistiquement significative n’a été notée pour la morphologie et la vitalité des spermatozoïdes (p = 0,276 et p = 0,075 respectivement). La leucospermie était associée à une bactériospermie chez 10 % des patients. Ureaplasma urealyticum était le germe le plus retrouvé (45,7 %) venaient ensuite les Streptococcacae et les Staphylococcacae 20,3 % chacun, les bacilles à Gram négatif représentaient 12,9 % alors que Corynebacterium spp n’a été isolé que chez 4,3 % des patients. La présence d’U. urealyticum a été associée à une hypospermie dans 33 % des cas (p = 0,031) et à une asthénospermie secondaire dans 39 % des cas avec TF = 0,002. L’asthénospermie a été également significativement associée à la présence de Corynebacterium (p < 0,001) et de Streptocoques (p = 0,04). Le genre Streptococcus a été également associée à une morphologie anormale des spermatozoïdes ; le TZI a été pathologique dans 46 % des cas dans le groupe 1 et dans uniquement 19 % des cas dans le groupe 2 (p = 0,046).
La présence d’une bactériospermie pourrait être impliquée dans l’altération des paramètres spermatiques. Le traitement de cette affection semble améliorer la fécondance des spermatozoïdes et prévient le risque de contamination des milieux de culture des gamètes fécondés.
Bacteriospermia may result in male hypofertlity. Indeed, 60% of patients treated by Assisted Reproductive Techniques had a local infection or inflammation of genital tract. However, direct effects of bacteriospermia on semen parameters remain controversial. The aim of our work was to explore the effect of bacteriospermia on sperm parameters among patients consulting for hypofertility.
A retrospective comparative study of two groups: a group of 70 patients with bacteriospermia (group 1) and a control group of 70 patients without bacteriospermia (group 2). For these groups, we studied the standard semen parameters (seminal volume and viscosity and spermatozoa count, initial and secondary mobility, vitality and morphology). Comparison of these parameters was made by the Chi² test and the Fisher test.
The mean age of our population was 40.4 ± 6.7 years. There was no significant difference between ejaculate average volume in the 2 groups (group B: 2.78 mL versus group A: 2.92 mL with P = 0.2). Similarly, for the viscosity no difference was noted (P = 0,68). The altered parameters in the presence of bacteriospermia were mean concentration and sperm motility (P = 0.001 and P = 0.049 respectively). The prevalence of secondary asthenospermia was higher in the presence of bacterospermia (P = 0.006). No statistically significant differences were observed for morphology and vitality of spermatozoa (P = 0.276 and P = 0.075 respectively). The leucospermia was associated with bacteriospermia in 10% patients. Ureaplasma urealyticum was the germ most found (45.7%) followed by Streptococcus and Staphylococcacae (20.3% for each), Gram negative rods accounted for 12.9%, while Corynebacterium spp was isolated only in 4,3% patients. U. urealyticum was associated with hypospermia in 33% of cases (P = 0.031). Spermatozoa motility was significatively decreased not only in the presence of this bacteria (FT = 0.002) but also when cultures were positive for Streptococcus (0.04) and Corynebacterium (P < 0.001). Morphological abnormalities were also noticed with Streptococcus with index of teratozoospermia of 46% versus 19% in the 2nd group (P = 0.046).
Bacteriospermia may impair sperm parameters. The treatment of this affection seems to improve sperm fertilizing potential. In addition, it could prevent contamination of culture media.

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AndrologyChlamydia trachomatis Infection Is Related to Poor Semen Quality in Young Prostatitis Patients

Abstract

Background

Objective

Design, setting, and participants

Interventions

Measurements

Results and limitations

Conclusions

Introduction

Section snippets

Study design

Results

Discussion

Conclusions

J Urol

J Infect

Eur Urol

Lancet Infect Dis

J Reprod Immunol

J Urol

Clin Immunol

Eur Urol

Impact of chronic prostatitis-like symptoms on the quality of life in a large group of men

BJU Int

Chlamydia trachomatis and male fertility

Hum Fertil (Camb)

Antibodies to Chlamydia trachomatis in semen and relationship with parameters of male fertility

Hum Reprod

Sexually transmitted infections: impact on male fertility

Andrologia

Ultrastructural observations on the entry of Chlamydia trachomatis into human spermatozoa

Hum Reprod

The 60 kDa heat shock protein in human semen: relationship with antibodies to spermatozoa and Chlamydia trachomatis

Hum Reprod

Andrology
Chlamydia trachomatis Infection Is Related to Poor Semen Quality in Young Prostatitis Patients