Update on the impact of Chlamydia trachomatis infection on male fertility

Abstract

With approximately 90 million cases annually, infection with Chlamydia trachomatis is the most prevalent sexually transmitted bacterial disease in the world. Considering that these infections are often asymptomatic and cause major complications like acute pelvic inflammatory disease, ectopic pregnancy, infertility or infant pneumonia, the estimated costs for diagnosis and treatment in the USA amounts to 2.2 million US dollars for each 500 cases. Therefore, there is a high need for correct, quick and cost-effective diagnosis and treatment of this urogenital tract infection. New innovative therapies provide good results with regard to efficacy and patients' compliance. The success rates of treatments are at least 95%. However, the occurrence of antibiotic resistance should not be ignored and new treatment schemes must be developed. The state-of-the-art of diagnosis and treatment of chlamydial infections as well as the pathophysiology is discussed in this review. In conclusion, infections with C. trachomatis is an important public health problem, especially in third world and developing countries, and more socio-economic studies linking secondary prevention of chlamydial infections, infertility and adverse pregnancy outcome are needed to understand more of its aetiology. In addition, diagnosis and treatment should be improved. Data in men revealed that past infections but not present infections are more related to male infertility. There is still controversial results. In future studies, function of the seminal vesicles and evaluation of the antioxidant capacity should be taken into account when role of C. trachomatis infection on male fertility is assessed.

Prevalence of genitalChlamydia trachomatisin Iran: a systematic review and meta-analysis

“…Excluded studies were: (1) those that used detection methods other than molecular amplification techniques, including culture or serological methods, such as enzyme-linked immunosorbent assay (ELISA) or immunofluorescence (IF), (2) studies reporting combined prevalence data for male and female participants and (3) those that studied chlamydial infections in organs or body sites other than the genitourinary tract.…”

“…trachomatis is one of the most common pathogens that cause sexually transmitted infections (STIs). 1 Although as much as two-thirds of women and 50% of men who are infected with this organism develop asymptomatic infections, 2 in the remaining population, this bacterium can cause a broad spectrum of genitourinary infections, such as non-and post-gonococcal urethritis, epididymitis and prostatitis in males 3 and cervicitis, salpingitis and pelvic inflammatory disease (PID) in females, which particularly in the chronic form may lead to ectopic pregnancy or exert negative effects on fertility. Furthermore, in vitro co-incubation of C. trachomatis with human spermatozoa can impair sperm motility and kill spermatozoa likely because of the bacterium lipopolysaccaride, 4 although the role of this pathogen in male infertility remains controversial.…”

Genital Chlamydia trachomatis infections

“…Allo stato attuale delle conoscenze, gli effetti dell'infezione da C.t. sull'infertilità maschile sembrerebbero tuttavia legati soprattutto alla qualità della risposta immune (43).…”

The Role of Chlamydia trachomatis in Male Infertility

“…An increased prevalence of an autoimmune response to sperm in men with C. trachomatis in semen suggests that a subclinical chlamydial infection may activate an immune response to sperm [8]. Witkin et al demonstrated that the presence of a humoral immune response to C. trachomatis is correlated with the development of an autoimmune response to spermatozoa [43].…”

“…One disadvantage of the culture is the low sensitivity of 70-85%. Furthermore, the costs, the high level of technical expertise necessary and the time required to obtain results, are significant disadvantages of this method [8,134]. Cycloheximide-treated McCoy or HeLa cell lines are used most frequently to isolate C. trachomatis.…”