Semen infections in men with primary infertility in the real-life setting.
OBJECTIVE
To study the impact of asymptomatic semen infections on seminal parameters in men presenting for primary couple's infertility.


DESIGN
Cross-sectional study.


SETTING
Academic center.


PATIENTS
Socio-demographic, clinical, and laboratory data from 1689 infertile men were analyzed.


INTERVENTION(S)
Semen analysis was based on 2010 World Health Organization reference criteria. Each patient underwent semen culture test to identify common urogenital pathogens. Infections by Mycoplasma, Ureaplasma, and Chlamydia spp. were evaluated through a real time polymerase chain reaction platform. Descriptive statistics and linear and logistic regression models were used to test the association between semen infections and clinical, seminal, and hormonal parameters.


MAIN OUTCOME MEASURE(S)
Prevalence of asymptomatic semen infection and impact of semen infection on sperm parameters.


RESULTS
Of 1689 men, 354 (21.0%) had an asymptomatic positive semen culture. Ureaplasma urealyticum (37.6%) was the most frequent single pathogen, followed by Enterobacteriaceae (any type; 24.8%), other pathogens (20.3%), Chlamydia trachomatis (3.4%) and Mycoplasma spp (3.4%). Positive semen cultures were associated with lower sperm concentrations (P<0.001) and progressive motility (P<.001). These latter findings were mostly particular to men with infections caused by Ureaplasma urealyticum compared with negative semen cultures. A positive semen culture was both univariably (P<.001) and multivariably (P=.04) associated with a lower sperm concentration.


CONCLUSION
One out of five men presenting for a couple's primary infertility had asymptomatic semen infections, which were significantly associated with impaired sperm concentration. These observations point out the importance of an accurate investigation of semen infection in the everyday clinical practice diagnostic workup of infertile men.
['Boeri|Luca|L|', 'Pederzoli|Filippo|F|', 'Capogrosso|Paolo|P|', 'Abbate|Costantino|C|', 'Alfano|Massimo|M|', 'Mancini|Nicasio|N|', 'Clementi|Massimo|M|', 'Montanari|Emanuele|E|', 'Montorsi|Francesco|F|', 'Salonia|Andrea|A|']
D000293:Adolescent D000328:Adult D058070:Asymptomatic Diseases D001424:Bacterial Infections D002689:Chlamydia D002690:Chlamydia Infections D003430:Cross-Sectional Studies D005298:Fertility D006801:Humans D007248:Infertility, Male D007558:Italy D008297:Male D009174:Mycoplasma D009175:Mycoplasma Infections D015995:Prevalence D012189:Retrospective Studies D018570:Risk Assessment D012307:Risk Factors D012661:Semen D013076:Sperm Count D014509:Ureaplasma D016869:Ureaplasma Infections D055815:Young Adult
semen analysis semen culture Male infertility risk factors urogenital infections