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Semen culture and the assessment of genitourinary tract infections
Michael Solomon1, Ralf Henkel1
1Department of Medical Biosciences, University of the Western Cape, Bellville, South Africa.
Abstract:
The male factor contributes approximately 50% to infertility-related cases in couples with an estimated 12%-35% of these cases attributable to male genital tract infections. Depending on the nature of the infection, testicular sperm production, sperm transport, and sperm function can be compromised. Yet, infections are potentially treatable causes of infertility. Male genital tract infections are increasingly difficult to detect. Moreover, they often remain asymptomatic ("silent") with the result that they are then passed on to the relevant sexual partner leading to fertilization and pregnancy failure as well as illness of the offspring. With the worldwide increasing problem of antibiotic resistance of pathogens, proper diagnosis and therapy of the patient is important. This testing, however, should include not only aerobic microbes but also anaerobic as these can be found in almost all ejaculates with about 71% being potentially pathogenic. Therefore, in cases of any indication of a male genital tract infection, a semen culture should be carried out, particularly in patients with questionable semen quality. Globally, an estimate of 340 million new infections with sexually transmitted pathogens is recorded annually. Among these, the most prevalent pathogens including Chlamydia trachomatis, Ureaplasma urealyticum, Neisseria gonorrhoeae, and Mycoplasma hominis. Escherichia coli are considered the most common nonsexually transmitted urogenital tract microbes. These pathogens cause epididymitis, epididymo-orchitis, or prostatitis and contribute to increased seminal leukocyte concentrations.
Insights
Male genital tract infections cause significant infertility and are often asymptomatic. Prompt semen culture is crucial for diagnosing and treating these infections, including both aerobic and anaerobic microbes, to improve reproductive outcomes.
Area of Science:
- Reproductive Medicine
- Urology
- Microbiology
Background:
- Male factor infertility accounts for ~50% of couple infertility cases, with 12%-35% linked to genital tract infections.
- These infections can impair sperm production, transport, and function, yet are treatable causes of infertility.
- Many genital tract infections are asymptomatic, leading to partner transmission, fertilization failure, and offspring illness.
Purpose of the Study:
- To highlight the significance of male genital tract infections as a treatable cause of infertility.
- To emphasize the diagnostic challenges posed by asymptomatic infections and the growing issue of antibiotic resistance.
- To advocate for comprehensive semen cultures, including anaerobic microbes, in evaluating male infertility.
Main Methods:
- Review of existing literature on male genital tract infections and their impact on fertility.
- Analysis of common aerobic and anaerobic pathogens, including sexually transmitted and non-sexually transmitted microbes.
- Discussion on diagnostic approaches and the importance of semen cultures.
Main Results:
- Male genital tract infections compromise testicular sperm production, sperm transport, and sperm function.
- Common pathogens include *Chlamydia trachomatis*, *Ureaplasma urealyticum*, *Neisseria gonorrhoeae*, *Mycoplasma hominis*, and *Escherichia coli*.
- Anaerobic microbes are prevalent in ejaculates and can be pathogenic, necessitating their inclusion in testing.
Conclusions:
- Male genital tract infections are a critical, often overlooked, cause of infertility.
- Comprehensive semen cultures are essential for accurate diagnosis and effective treatment, especially given antibiotic resistance.
- Addressing these infections can significantly improve fertility outcomes for couples.
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