Summary The impact of sexually transmitted diseases (STD) on male fertility is strongly dependent on the local prevalence of the STDs. In Western countries STD‐infections are of minor relevance. In other regions, i.e. Africa or South East Asia, the situation appears to be different. Acute urethritis could not be associated with male infertility. Chronic infections (gonorrhoea) can cause urethral strictures and epididymo‐orchitis. Chlamydia trachomatis and Neisseria gonorrhoea can be transmitted to the female partner and cause pelvic inflammatory disease with tubal obstruction. Ureaplasma urealyticum may impair spermatozoa (motility, DNA condensation). Trichomonas vaginalis has, if any, only minor influence on male fertility. The relevance of viral infections (HPV, HSV) for male infertility is not resolved. Any STD increases the chances of transmission of the human immunodeficiency virus (HIV). The HIV infection is associated with infectious semen and the risk of virus transmission. Semen quality deteriorates with the progression of immunodeficiency. Special counselling of serodiscordant couples is needed. STDs should be treated early and adequately to prevent late sequelae for both men and women.
In previous years the physiologic and pathophysiologic significance of reactive oxygen species (ROS) on sperm function has been recognized. The impact of ROS during the invasion, adhesion and multiplication of microorganisms in the male genital tract are largely unknown. However, it is known that the resulting activation of leukocytes leads to an increased generation of ROS. There is growing evidence that spermatozoa are protected from detrimental ROS effects by the powerful antioxidants in seminal plasma since disturbances of sperm function by ROS were demonstrated in the absence of seminal plasma, i.e., during epididymitis or after semen preparation. If seminal plasma is present, ROS generated by physiologic numbers of granulocytes ( < 1 x lo6 ml-') apparently do not damage spermatozoa. Interestingly, ROS generated by leukocytes during male genital tract infections are critical for the techniques of semen preparation for assisted reproduction. These ROS impair sperm function if the protective effects of seminal plasma are not present. The relevance of ROS production by higher leukocyte numbers in human semen is presently unknown as is the relevance of ROS generated in the female reproductive tract.In previous years the ambiguous role of reactive oxygen species (ROS) generation in human semen has been recognized. On one hand, ROS appear to be involved in physiologic reactions such as capacitation (De Lamirande & Gagnon, 1995; Griveau et al., 1995a), while on the other hand, there is ample evidence that an increased ROS production impairs sperm functions and the fertilizing capacity of spermatozoa (Ochsendorf &
Owing to a misunderstanding a 26-year-old man took for malaria prevention 2 tablets (1.0 g) chloroquine daily instead of the recommended dose of two tablets weekly. After 2 weeks he developed vertigo, generalized weakness and, after sun-bathing, severe bullous light reaction. After 4 weeks generalized hair depigmentation occurred. Two weeks later abnormal accommodation and double vision set in so that he lost distant and near vision. All these signs disappeared after the drug was discontinued (vertigo, weakness and abnormal accommodation within 2 weeks; hair regrew in normal colour after 8 weeks). This case shows the whole spectrum of subacute chloroquine overdosage.
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