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

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.

Subclinical leishmaniasis associated with infertility and chronic prostatitis in a dog.

A stud dog was presented for acquired infertility. Haematospermia and teratozoospermia were found on two ejaculates 2 weeks apart. A presumptive diagnosis of prostatitis was made follo-wing ultrasound examination. An ultrasound-guided needle core biopsy was performed under general anaesthesia, revealing a mild chronic macrophagic and plasma cell prostatitis with intracytoplasmic amastigotes consistent with Leishmania spp. infection. Presence of Leishmania infantum, Leishmania donovani or Leishmania chagasi was confirmed by polymerase chain reaction in seminal plasma. Serology and serum protein electrophoresis confirmed the diagnosis of a subclinical active systemic leishmaniasis. A meglumine antimoniate and allopurinol treatment was given which clearly improved within 3 months both general condition and the quality of sperm. To the authors' knowledge, this is the first reported case of a prostatitis secondary to a Leishmania spp. infection. Subclinical systemic leishmaniasis should be considered in the differential diagnosis of infertility in dogs suffering from semen alterations.

Trypanosomiasis-induced infertility in dromedary (Camelus dromedarius) bulls: changes in plasma steroids concentration and semen characteristics.

The effect of Trypanosomiasis on concentrations of plasma steroids and semen characteristics was studied in 24 dromedary bulls. Based upon the parasitological and serological diagnosis, 18 bulls were found infected with Trypanosoma evansi (Group 2) and six were found to be free from infection and served as controls (Group 1). The infected animals exhibited signs of anaemia indicated by the decrease of packed cell volume (PCV) and haemoglobin concentration (Hb), pale mucus membranes, weight loss, lethargy, weakness and dullness. However, five animals (27.8%) of the infected group revealed elevated rectal temperatures and three animals (16.7%) revealed testicular degeneration upon palpation of their scrotal contents. Concentrations of plasma oestradiol-17beta (86.5 +/- 8.6 pg/ml versus 232.5 +/- 74.4 pg/ml) and testosterone (4.8 +/- 0.7 ng/ml versus 2.7 +/- 1.5 ng/ml) were significantly different (P < 0.05) between the control and infected bulls. Evaluation of the semen collected by electroejaculation and evaluated by a computerized cell motion analyzer revealed normal semen characteristics in the control animals compared to deteriorated ones in the infected bulls. There were highly significant (P < 0.01) decreases in sperm count (12.2 +/- 1.3/ml versus 6.5 +/- 4.9 x 10(6)/ml), motility percentage (68.2 +/- 6.7% versus 27.4 +/-15.6%), percentage of live spermatozoa (73.2 +/- 8.3% versus 35.8 +/- 8.2%) and increases in percentage of morphological abnormalities (3.3 +/- 0.6% versus 15.9 +/- 1.0%) in the infected group. An examination of the plasma hormonal profiles and semen characteristics in the infected bulls indicated that altered Sertoli cell function due to formation of immune complexes in four bulls (Group 2A), pituitary dysfunction in six bulls (Group 2B), testicular degeneration in three bulls (Group 2C) and finally trypanotolerancy in five bulls (Group 2D) are possible factors responsible for poor semen characteristics and infertility induced by T. evansi infection in dromedary bulls.

Microsurgical epididymal sperm aspiration with motile trophozoite cells but no spermatozoa.

This paper reports on a patient in whom the clinical diagnosis of obstructive azoospermia was made according to clinical observations, i.e. azoospermia, normal andrological examination, normal follicle stimulating hormone and a misleading histopathological report of a testicular biopsy. Microsurgical vasoepididymostomy failed to restore fertility, and as a last resort, microsurgical sperm aspiration was performed. Although flagellated cells were observed in the epididymal aspiration, no spermatozoa were observed and wet preparation of multiple testicular biopsies failed to demonstrate any spermatozoon. This patient was diagnosed to have a non-obstructive azoospermia, resulting from maturation arrest associated with trichomonas infection at the level of the epididymis.

Electron microscopy of Chlamydia trachomatis infection of the male genital tract.

Semen specimens and testicular and epididymis biopsy from a patient of an infertile marriage were examined by transmission electron microscopy. Intraepithelial vesicles containing C. trachomatis were present in remaining cytoplasmic droplets in spermatozoa, desquamated epithelial cells, and stereocilia from epididymis. Elementary bodies were demonstrated in connective tissue from testes and in Leydig cells. The association between the microorganisms and spermatozoa contribute to the decreased motility and necrospermia. The morphologic alterations in epididymis are responsible for decreased sperm maturation. The damage to Leydig cells can be demonstrated only by electron microscopy.