Screening for bacterial pathogens in semen samples from infertile men with and without leukocytospermia

Abstract

We aimed to study the correlation between leukocyte counts in semen and bacterial pathogens in seminal samples of infertile men, and to establish the minimum leukocyte count associated with significant bacteriospermia. A total of 116 patients who underwent evaluation of fertility were investigated using routine semen analysis according to the guidelines of the WHO and bacterial pathogens analysis by culture and in-house PCR assay. The overall prevalence of bacteriospermia in semen samples was 56.9% independent of the presence of leukocytes. The most common bacterial species detected were Chlamydia trachomatis (41.4%), Ureaplasma urealyticum (15.5%) and Mycoplasma hominis (10.3%). The receiver operating characteristic curve analysis demonstrated that the sensitivity/specificity for detecting bacteria at a cut off level of >or=1 x 10(6) leukocytes per ml (which is the WHO defined level for leukocytospermia) was 20.3%/81.5%. The highest sensitivity/specificity ratio was found in semen samples with a cut-off level of >or=0.275 x 10(6) leukocytes per ml, which is best shown with the odds ratio of 2.47. A significant correlation was found between bacteriospermia and leukocytospermia at the cut-off level of >or=0.275 x 10(6) leukocytes per ml of semen samples (P = 0.032). We proposed that this is a possible new cut-off level to predict the presence of bacteria in semen of infertile men.

Is semen polymorphonuclear leucocytes count a good predictor of male genital tract infection?

“…The prevalence of bacteriospermia in semen samples varies across different studies -51% (5) in Cottell et al's study, 35.7% (4) and 51.1% (6) in Lackner et al's studies, 56.9% (7) in Gdoura et al's study, and 63.9% (11) in Rodin et al's study. The prevalence of bacteriospermia in the present study was 18.6%, which is much lower than those previously reported.…”

“…We feel that an increased PMN count is not an indicator for antibiotic treatment, and that anti-inflammatory agents may be effective in lowering the PMN count. Also, reactive oxygen species, proteases and cytokines resulting from an increased PMN count have been considered the mechanism of sperm damage in a study by Gdoura et al (7) Using a COX-2 inhibitor, Lackner et al were able to reduce leucocytospermia and increase sperm count in patients with abacterial leucocytospermia. (4) In sexual reproduction, the female genital tract has lysozymes, phagocytes and lactic acid, which function as a natural defence mechanism against microbial infection from semen.…”

“…Directly detecting bacteria in semen is not feasible since it requires a Gram stain, which is not commonly used in semen analysis, (1) and has a high false negative rate. Cross-sectional studies by Lackner et al (6) and Gdoura et al (7) have also compared the culture positivity of the semen of patients with and without leucocytospermia.…”

“…Directly detecting bacteria in semen is not feasible since it requires a Gram stain, which is not commonly used in semen analysis, (1) and has a high false negative rate. Cross-sectional studies by Lackner et al (6) and Gdoura et al (7) have also compared the culture positivity of the semen of patients with and without leucocytospermia.Since there has been no published studies on the Singapore population so far, we aimed to determine whether an increased PMN count in semen is a good predictor of the presence of male genital tract infection, which is detected by semen culture. Is semen polymorphonuclear leucocytes count a good predictor of male genital tract infection?…”

The Role of Chlamydia trachomatis in Male Infertility

“…However, Punab et al observed a positive correlation between the leukocyte count and the number of different bacteria detected in semen, and also between the leukocyte count and the total count of microorganisms in semen samples [77]. In fact, these authors along with Gdoura et al [78] demonstrated that the WHO-defined cut-off point (1x10 6 leukocytes per mL) has very low sensitivity for discriminating between patients with and without significant bacteriospermia, as a more optimal sensitivity/specificity ratio appears at 0.2x10 6 leukocytes per mL of semen.…”