AndrologyChlamydia trachomatis Infection Is Related to Poor Semen Quality in Young Prostatitis Patients
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.
References (29)
- et al.
Prevalence, incidence estimation, risk factors and characterization of chronic prostatitis/chronic pelvic pain syndrome in urological hospital outpatients in Italy: results of a multicenter case-control observational study
J Urol
(2007) - et al.
Chlamydia trachomatis occurrence and its impact on sperm quality in chronic prostatitis patients
J Infect
(2006) - et al.
Interleukin 8 and anti-Chlamydia trachomatis mucosal IgA as urogenital immunologic markers in patients with C. trachomatis prostatic infection
Eur Urol
(2007) - et al.
Can Chlamydia trachomatis directly damage your sperm?
Lancet Infect Dis
(2005) - et al.
Enrichment of gamma delta T lymphocytes in human semen: relation between gamma delta T cell concentration and antisperm antibody status
J Reprod Immunol
(1992) - et al.
Leukocytes and bacteria in men with chronic prostatitis/chronic pelvic pain syndrome compared to asymptomatic controls
J Urol
(2003) - et al.
Presence of INFgamma-secreting lymphocytes specific to prostate antigens in a group of chronic prostatitis patients
Clin Immunol
(2005) - et al.
Are antisperm antibodies really associated with proven chronic inflammatory and infectious diseases of the male reproductive tract?
Eur Urol
(2009) - et al.
Impact of chronic prostatitis-like symptoms on the quality of life in a large group of men
BJU Int
(2007) - et al.
Chlamydia trachomatis and male fertility
Hum Fertil (Camb)
(2004)
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
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