How to Detect Chlamydia trachomatis in Males?

Abstract

Much is known about the role of Chlamydia trachomatis in female infertility, although the same cannot be said about the organism's role in male infertility. Recently a number of researchers have provided a possible explanation of the pathogenesis of C trachomatis in male infertility and have suggested further studies. Unfortunately, current screening recommendations for C trachomatis in an infertile couple are vague and unhelpful, and many do not even mention this type of screening in the male. To enable any progress to be made in this field, it is essential that investigators know how best to detect C trachomatis, especially in the male. It is important, therefore, to know which specimen is best for C trachomatis detection, with respective strengths and weaknesses of each specimen. Similarly, it is equally important to have knowledge of which test is appropriate for the type of specimen being examined. First void urine is currently the specimen of choice for the routine detection of C trachomatis in males. Moreover, the best detection protocols in the developed world are based on molecular diagnosis of first void urine. These methods provide the best combination of sensitivity and specificity that is currently available on a clinical sample that can be self-taken. Interestingly, because semen is routinely collected for analysis in men of infertile couples, it has been suggested that protocols be developed for the optimal detection of C trachomatis in this specimen. Semen might provide additional information on infection of the upper genital tract, which may not be detected in first void urine. Finally, the importance of comparing tests for C trachomatis detection in updating our knowledge has been highlighted by the inability of some molecular methods to detect the new variant strain of C trachomatis.

Chlamydial Infection and Its Role in Male Infertility

“…However, patients testing positive for C. trachomatis DNA in semen specimens and negative for C. trachomatis DNA in urethral samples may indicate that C. trachomatis resides in the male secretory glands and as such may serve as a marker for an invasive Chlamydial infection [51]. Unfortunately, there is no approved methodology for the testing of semen for C. trachomatis [49,52]. In fact, the question as to whether semen is a suitable sample for detection of C. trachomatis in infertile men is not even completely clear [52], as components of seminal fluid have been shown to be toxic to cell culture growth [53].…”

“…Unfortunately, there is no approved methodology for the testing of semen for C. trachomatis [49,52]. In fact, the question as to whether semen is a suitable sample for detection of C. trachomatis in infertile men is not even completely clear [52], as components of seminal fluid have been shown to be toxic to cell culture growth [53]. Attempts to dilute semen to decrease the toxicity have resulted in a decreased sensitivity to detect C. trachomatis [50,54].…”

“…Historically, Chlamydia was grown in culture; however this was replaced in many centers by antigen detection [52]. This indirect approach is inherently flawed but nonetheless has been extensively utilized.…”

Comparative Levels of Immunoglobulin A Urethral Mucosa in Asymptomatic <i>Chlamydia trachomatis</i> Infections in the Prison

“…which is an obligate intracellular bacterium that require living cells to proliferate. [1] CT infection is known as a silent disease because infected individuals are asymptomatic. If these individuals are not diagnosed and not given treatment, then they become a reservoir of the disease and will lead to longterm complications.…”

Swabs (dry or collected in universal transport medium) and semen can be used for the detection of Chlamydia trachomatis using the cobas 4800 system

“…In our routine practice, we use swab material discharged in bacterial transport medium to be tested by cell and standard culture and by PCR. In men, first-void urine is currently the specimen of choice for the routine detection of C. trachomatis and N. gonorrhoeae, with little or no emphasis placed on testing of semen because the urine sample is easy to collect, is a non-invasive sample and contains a high organism load (Eley, 2011). In France, however, all semen specimens for in vitro fertilization are screened for C. trachomatis.…”