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Male infertility: a public health issue caused by sexually transmitted pathogens

Key Points

  • Sexually transmitted diseases (STDs) can induce male infertility through multiple pathophysiological mechanisms

  • Several STD-causing agents, including bacteria, viruses and protozoa have been detected in semen from symptomatic and asymptomatic males, and can be transmitted through natural intercourse or insemination

  • STD pathogens can affect sperm parameters and functions, particularly when testicular, accessory gland and urethral infections localize the disease agents in proximity to semen

  • Several highly sensitive and specific molecular methods are now available to explore the relationship between infertility and infections of semen with STD pathogens

  • Chlamydia trachomatis, Ureaplasma spp., human papillomavirus, hepatitis B and C viruses, HIV-1 and human cytomegalovirus are associated with reduced sperm quality, concentration and motility

Abstract

Sexually transmitted diseases (STDs) are caused by several pathogens, including bacteria, viruses and protozoa, and can induce male infertility through multiple pathophysiological mechanisms. Additionally, horizontal transmission of STD pathogens to sexual partners or vertical transmission to fetuses and neonates is possible. Chlamydia trachomatis, Ureaplasma spp., human papillomavirus, hepatitis B and hepatitis C viruses, HIV-1 and human cytomegalovirus have all been detected in semen from symptomatic and asymptomatic men with testicular, accessory gland and urethral infections. These pathogens are associated with poor sperm quality and decreased sperm concentration and motility. However, the effects of these STD agents on semen quality are unclear, as are the effects of herpes simplex virus type 1 and type 2, Neisseria gonorrhoeae, Mycoplasma spp., Treponema pallidum and Trichomonas vaginalis, because few studies have evaluated the influence of these pathogens on male infertility. Chronic or inadequately treated infections seem to be more relevant to infertility than acute infections are, although in many cases the exact aetiological agents remain unknown.

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Figure 1
Figure 2: Sexually transmitted disease loci in the male genital tract and their relation to infertility.
Figure 3: Interaction of sexually transmitted disease pathogens with spermatogenic cells and spermatozoa.

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Acknowledgements

This work was supported by grants from Coordenação de Aperfeiçoamento de Pessoal de Nível superior (CAPES) and Instituto Nacional de Ciência e Tecnologia para Inovação terapêutica (INCT-if), Brazilian Government.

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All authors researched data for the article. F.G., R.P.S., J.C.B., J.J.V.T., M.G.B. and M.E.L.C. contributed substantially to discussion of content. F.G., R.P.S. and M.E.L.C. wrote the article, and J.C.B., J.J.V.T., S.S.M.-E. and M.G.B. contributed to review and editing of the manuscript before submission.

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Gimenes, F., Souza, R., Bento, J. et al. Male infertility: a public health issue caused by sexually transmitted pathogens. Nat Rev Urol 11, 672–687 (2014). https://doi.org/10.1038/nrurol.2014.285

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