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Sexually transmitted infections and semen quality from subfertile men with and without leukocytospermia

Reproductive Biology and Endocrinology volume 19, Article number: 92 (2021) Cite this article

A Correction to this article was published on 19 April 2022

This article has been updated

Abstract

Background

The role of sexually transmitted infections (STIs) in semen parameters and male infertility is still a controversial area. Previous studies have found bacterial infection in a minority of infertile leukocytospermic males. This study aims to investigate the prevalence of STIs in semen from subfertile men with leukocytospermia (LCS) and without leukocytospermia (non-LCS) and their associations with sperm quality.

Methods

Semen samples were collected from 195 men who asked for a fertility evaluation. Infection with the above 6 pathogens was assessed in each sample. Sperm quality was compared in subfertile men with and without LCS.

Results

The LCS group had significantly decreased semen volume, sperm concentration, progressive motility, total motility and normal morphology. The infection rates of Ureaplasma urealyticum (Uuu), Ureaplasma parvum (Uup), Mycoplasma hominis (MH), Mycoplasma genitalium (MG), Chlamydia trachomatis (CT), herpes simplex virus-2 (HSV-2) and Neisseria gonorrhoeae (NG) were 8.7 %, 21.0 %, 8.2 %, 2.1 %, 3.6 %, 1.0 and 0 %, respectively. The STI detection rates of patients with LCS were higher than those of the non-LCS group (52.3 % vs. 39.3 %), although there was no statistically significant difference between the two groups (P = 0.07). All semen parameters were not significantly different between LCS with STIs and without STIs, except the semen volume in the MG-infected patients with LCS was significantly lower than that in the noninfected group.

Conclusions

LCS was associated with a reduction in semen quality, but was not associated with STIs.

Introduction

Up to 30 % of infertile men have leukocytospermia which refers to the presence of a high concentration (≥ 1 × 106/ml) of white blood cells (WBCs) in semen [1]. Leukocytes, including granulocytes (50–60 %), macrophages (20–30 %) and T lymphocytes (2–5 %), have been shown to be a negative factor for semen quality as they induce low sperm motility [2]. The origin of leukocytes in the ejaculate is mainly from the epididymis and is associated with immunosurveillance [3]. Hence, bacterial and viral infections were considered and detected in semen from symptomatic and asymptomatic leukocytospermic infertile males, although they attending andrology clinics often do not have an apparent infection.

More than 30 sexually transmitted infections (STIs), including herpes simplex virus (HSV), Chlamydia trachomatis (CT), Ureaplasma spp. (UU), Mycoplasma hominis (MH), Mycoplasma genitalium (MG) and Neisseria gonorrhoeae (NG) have been identified as pathogens that cause genital injury, semen infection, prostatitis, urethritis, epididymitis and orchitis in men [4,5,6,7]. Previous studies observed sexually transmitted pathogens in semen in relation to impaired sperm quality and reduced pregnancy rates [8, 9]. However, unlike the strong negative correlation between STIs and fertility in females, the link in males remains controversial [10]. For example, several studies demonstrated that UU increased secondary infertility and reduced sperm quality, including low sperm concentration and motility [11], while other studies did not find a correlation between UU and semen paremeters [12, 13]. Interestingly, UU can be divided into two subtypes, Ureaplasma urealyticum (Uuu) and Ureaplasma parvum (Uup), and studies have shown that Uup is more associated with poor semen quality than Uuu due to differential pathogenicity [14]. Thus, the controversial results in previous studies may be due to the lack of discrimination between Uuu and Uup.

Recent studies reported that compared with patients with nonleukocytospermia (non-LCS), decreased semen parameters (e.g., sperm concentration, progressive motility, normal morphology) were observed in asymptomatic leukocytospermia (LCS), while those with STI (e.g., UU)-positive leukocytospermia performed more significantly [5, 15]. In this study, we aimed to investigate the prevalence of sexually transmitted pathogens by molecular methods in semen samples from infertile men with and without leukocytes and their effects on semen quality.

Methods

Patients

A total of 195 men who sought a fertility evaluation at the Reproductive Center of The First Affiliated Hospital of University of Science and Technology of China (USTC) from July 2019 to July 2020 were included in this study. The exclusion criteria were men who were diagnosed with genetic defects related to reproductive tract, azoospermia, varicocele, testicular trauma, cryptorchidism, postmumps orchitis and chronic severe debilitating medical illnesses. This study was approved by The First Affiliated Hospital of USTC Ethical Committee, Anhui, China (No. 2019P040).

Semen analysis

The semen volume, sperm concentration, total sperm count, motility, and morphological normality were determined according to the WHO 2010 guidelines for semen analysis (fifth edition, 2010) [1]. Briefly, semen samples were obtained after an abstinence period of 2–7 days. Semen quality was evaluated after liquefaction at 37 °C for at least 30 min. Semen volume was calculated by weighing the semen sample in a tube. Computer-assisted sperm analysis (CASA) was used to measure sperm concentration, progressive motility and total motility (SAS, Beijing, China). Sperm morphology was determined through Diff-Quick staining (Anke Biotechnology, Hefei, China). Leukocytes were stained by peroxidase test using benzidine (Anke Biotechnology, Hefei, China). Antisperm antibodies (AsAs) were investigated by the mixed antiglobulin reaction (MAR) method (Anke Biotechnology, Hefei, China).

Laboratory personnel were trained in semen collecting and detecting procedures according to the National Research Institute for Family Planning. In addition, the laboratory participates in an external quality control (EQA) program by NHC Key Laboratory of Male Reproduction and Genetics.

Detection of sexually transmitted pathogens

For each male patient, 200 µL of semen specimens was used for the extraction of microorganism DNA. Amplified Sexually transmitted pathogen DNA, including Uuu, Uup (Uup1, Uup3, Uup6, and Uup14), CT, HSV-2, MH, MG and NG, was detected by the “flow-through hybridization” technique using the STD (sexually transmitted disease) 6 GenoArray Diagnostic kit [16]. Samples infected with any pathogen were assigned to the pathogen-infected group, those with no infection with any pathogen were assigned to the non-infected group.

Statistical analysis

Qualitative variables were described as frequencies (percentages), and quantitative variables were described as the mean ± standard deviation (SD) if normally distributed and medians (interquartile range, IQR) if not. Pearson’s chi-square test and Student’s t-test were used for parametric comparisons, and the Mann-Whitney U test was utilized for nonparametric comparisons. In addition, comparison of sexually transmitted pathogens (Uuu, Uup3, Uup6, MH, MG and CT) were performed by the Kruskal-Wallis test with multiple comparisons. Abnormal semen parameters according to the WHO 2010 recommended standards were listed as follows: semen volume < 1.5 mL, sperm concentration < 15 × 106/mL, progressive motility < 32 × 106/mL and motility morphology < 4 %. P value < 0.05 was considered to indicate statistical significance. All statistical analyses were performed using SPSS version 17 (SPSS Inc., Chicago, IL, USA).

Results

Table 1 displays the mean (± SD) and median (25th, 75th) clinical characteristics and semen parameters from 195 men in the present study. The ages of patients with LCS and without LCS were 32.4 ± 6.9 and 31.6 ± 5.8 years, respectively. Of the studied population, more than 50 % of patients graduated from college/university. A total of 60.0 % of patients were diagnosed with primary infertility. Drinking and smoking were found in 70.3 and 42.6 % of patients, respectively. There was no significant difference between the two groups regarding age, clinical conditions (e.g., BMI, education, duration of infertility, and type of infertility) or lifestyle (e.g., smoking and drinking).

Table 1 Characteristics and descriptive statistics of the whole cohort
Full size table

As expected, the median leukocytes in the LCS and non-LCS groups were 4.3 and 0.2, respectively (Table 2). The median (25th, 75th) semen volume from LCS and non-LCS group were 2.8 (1.9, 3.7) and 3.0 (2.2, 4.1) (P = 0.04); sperm concentration were 66.4 (28.2, 106.0) and 89.5 (54.5, 135.5) (P = 0.01); progressive motility were 33.8 (19.1, 45.1) and 41.6 (16.7, 54.6) (P = 0.02); total motility was 40.8 (22.5, 55.2) and 50.2 (21.4, 63.8) (P = 0.03); and normal morphology was 5.0 (3.0, 7.0) and 5.0 (4.0, 8.0) (P = 0.35), respectively. The LCS group had significantly decreased semen volume, sperm concentration, progressive motility, total motility and normal morphology. In addition, there were no significant differences between the two groups for AsAs.

Table 2 Frequency of STI pathogens in semen samples
Full size table

As shown in Table 2, the STI-positive semen in subfertility patients was 45.1 %. The STI detection rates of patients with LCS were higher than those of the non-LCS group, (52.3 % vs. 39.3 %), although there was no statistically significant difference between the two groups (P = 0.07). Of 195 semen samples, UU accounted for 58 (29.2 %), which was the most prevalent pathogen detected, followed by MH (8.2 %), CT (3.6 %), MG (2.1 %) and HSV-2 (1.0 %). NG was not detected in any semen sample. Strikingly, the rate of MG-positive samples from the LCS group was significantly higher than that in the non-LCS group (P = 0.04), while other STI pathogens were similarly detected between the two groups.

Table 3 shows that 13 of the 71 STI-positive samples contained more than one pathogen, including 7 and 6 coinfected samples in the LCS and non-LCS groups, respectively. For the LCS group, 4 and 3 semen samples had 2 and 3 pathogens detections, respectively. Specifically, 5 of 7 semen samples were positive for UU and MH, 3 were positive for UU and MG and 1 was positive for UU and CT. For the non-LCS group, 5 and 1 of these samples were positive for 2 and 3 pathogens, respectively.

Table 3 Total simultaneous STI pathogens detected in the LCS and non-LCS groups
Full size table

The semen parameters from the LCS and non-LCS groups are summarized in Table 4. In both the LCS group and the non-LCS group, semen parameters were similar between patients with STI detection and those without STI detection. Moreover, the prevalence of STI pathogens in patients with normal semen parameters was not significantly different from that in patients with abnormal semen parameters (e.g., semen volume < 1.5 mL, sperm concentration < 15 × 106/mL, progressive motility < 32 × 106/mL, total motility < 40 × 106/mL and motility morphology < 4 %).

Table 4 Comparison of semen parameters in patients with LCS and non-LCS
Full size table

Table 5 list the association of semen quality and STI pathogens in the LCS group. All semen parameters were not statistically significant for the UU-infected patients, particularly for Uuu-, Uup3- and Uup6-positive patients. Interestingly, multiple comparison analysis found that semen volume was significantly different among groups. Semen volume was lower in patients with MG infection than in those without any STI pathogen detection. Furthermore, leucocytes in semen were not significantly different between the individual STI-positive and STI-negative groups.

Table 5 Sexually transmitted infections on semen quality in patients with LCS
Full size table

Discussion

During the past decade, the association of STI pathogens, leukocytes and semen quality in male infertility has remained a controversial topic [15]. In this context, we examined the effect of STI pathogenson semen quality in subfertile men with LCS and without LCS using the STD6 GenoArray Diagnostic assay. The method allows the detection of six STI pathogens (NG, CT, UU (Uuu, Uup), MH, MG and HSV-2). The prevalence of STI pathogens in semen samples from men with and without leukocytospermia was 52.3 and 39.3 %, respectively. We also showed that men with MG infection had lower semen volumes than men without infection in the LCS group. However, semen parameters were not significantly different between UU-positive and STI-negative patients.

A wide range of STI-positive percentages were observed in semen samples from infertile men, and this wide range of variability may be due to different types of studied populations, sample sizes and detection methods for STI pathogens [17, 18]. The diagnosis of STIs and therefore therapy is difficult and debated in relation to its association with male fertility [19]. A number of studies have identified the presence of pathogenic bacteria in semen based on culture or PCR [18]. Due to the limitations of culture methods, such as time consumption and low specificity, PCR-based diagnostic methods present rapid and sensitive detection of STI pathogens [20, 21]. In this study, we detected STI pathogens from semen samples by the GenoArray assay, which is a qualitative PCR-based in vitro test and rapid identification of mutations related to STD6 in a single test. Hence, this assay could be a potential screening method for semen pathogens in infertility or STD clinics.

HSV infections are associated with abnormal sperm parameters and male infertility by indirectly causing immune responses [22, 23]. Approximately 2–50 % of infertile men were positive for HSV-1/2 DNA [24, 25]. In the current study, the prevalence of HSV-2 pathogens in semen from subfertility patients was 1.0 %, with no difference between the LCS and non-LCS groups. As a low rate of HSV-2 positive semen samples was detected, we did not observe an association of HSV-2 with semen quality.

CT infects the genital tract, resulting in a decrease in seminal volume, sperm concentration, motility and normal morphology [26]. Current studies show that the prevalence of CT is 0.4–42.3 % in asymptomatic males [9]. We observed that the rate of CT-positive semen samples was 3.6 % from subfertility patients. Additionally, CT was associated with a slight decrease in semen volume. The mechanism by which CT affects sperm quality has not yet been elucidated.

NG infection has been associated with urethritis, epididymitis and prostatitis inflammation and thus can lead to infertility. However, the prevalence of NG pathogens was 0-6.5 %, with lower prevalence in infertile men than in men with other STI pathogens [18, 27]. Thus, few studies have investigated its correlation with semen parameters. Similar to previous studies, we detected no NG infection in semen samples from subfertility patients with and without LCS.

UU is the most common microorganism of the lower genitourinary tract in males and is a potentially pathogenic species with an etiologic role in male infertility [28]. The UU-positive rate in the semen samples of infertile men ranges from 5 to 42 %. Historically, the association of CT with semen parameters has been inconsistent. Some of the studies pointed out that UU-positive semen had lower sperm concentrations and sperm motility than UU-negative semen. However, other studies did not observe any correlation between UU and semen parameters [29]. Of interest, our present study confirmed that UU was the most common widespread pathogen in semen (29.2 % of positive samples), with no difference in UU infection between subfertile men with LCS and without LCS. A previous study reported that the frequency of Uuu in the semen of infertile men was higher than that of Uup, indicating that Uup may have a lower correlation with infertility. In this study, we observed a higher prevalence of Uup compared with Uuu in sub-fertile men. Indeed, there was no significant association between semen quality and Uuu and Uup infections. Although we did not find an obvious impact of UU on semen quality, further work exploring the different UU species induced infertility is required.

MH is an STI pathogen that often causes gynecologic and obstetric complications in females, such as postabortion fevers, rupture of fetal membranes, and pelvic inflammatory disease [30]. Although MH is commonly detected in men with nongonoccocal urethritis (NGU), its role in sperm function and male fertility remains unclear. The prevalence of MH in our study was comparable to that reported by Gdoura et al. (8.2 % vs. 9.2 %) [29]. The detection rate of MH was higher in patients with LCS than in those without LCS, although the difference was not statistically significant, suggesting a possible relationship between MH infection and male infertility.

The bacterium MG was isolated and identified as an STI pathogen in two urethral specimens from men with NGU. Studies also showed that the rate of MG infection was higher in symptomatic patients than in asymptomatic patients [31, 32]. Previously, up to 17.1 % of infertile men had MG infection [33], indicating that this pathogen may be important for male fertility outcomes. In line with another study, the prevalence of MG in asymptomatic patients was not high (2.1 %) [34]. In addition, we observed that the MG-positive rate of subfertile men with LCS was higher than that of men without LCS, suggesting a link between the presence of MG pathogens and male infertility. Regarding semen quality parameters, there was a decrease in seminal volume in the sample with MG infection compared to that without MG infection. Therefore, our results confirm that MG infection of the male genital tract could induce infertility. Due to the high azithromycin treatment failure rate (37.4 %) for MG infection in men of infertile couples in China, we should notice that inflammatory changes caused by MG long-term infection result in infertility [33].

According to infertility, men with LCS had a reduction in fructose concentration compared with non-LCS men, and LCS may affect seminal vesicle function. STI pathogens, including MG and CT, are associated with low semen volume, suggesting that subclinical infections seem to affect epididymal function.

There are several strengths of our findings. First, we showed a high rate of STI pathogens in asymptomatic subfertile men. The prevalence of STI pathogens was not associated with the leucocyte counts in semen, thus suggesting that the determination of more than 106 peroxidase- positive cells per milliliter cannot discard STIs and asymptomatic genital tract infections. Second, in this cross-sectional study, we showed that subfertile men with STIs had worse semen volumes than those without infection. Because of the probable impact of infection on semen quality, some tests performed for STI detection in leukocytospermia should be questioned. Thus, screening for STI pathogens could be part of the routine diagnostic workup of subfertile men.

The present study has inherent limitations. First, this study has a possible selection bias because this was a single center-based cross-sectional study. Second, a control group of normal fertile men is lacking. Third, due to a lack of antibiotic therapy against STI pathogens, the potential impact of infection treatment could not be assessed. A final limitation of the study is the small sample size and the results need to be validated with a larger number of patients. Nevertheless, our observations show the importance of investigating semen infection in the clinical practice diagnostic workup of subfertile men.

Overall, we demonstrated that STI pathogens were detected at a high rate in semen samples from asymptomatic subfertile men using a sensitive molecular assay, with no difference in prevalence between the LCS and non-LCS groups. LCS was associated with a reduction in semen quality, but was not associated with STIs. Thus, the present study finding may be beneficial for clinicians to perform an assessment of the association of STIs and subfertile men with LCS.

Availability of data and materials

The datasets analyzed during this study are available from the corresponding author.

Change history

Abbreviations

STIs:

Sexually transmitted infections

LCS:

Leukocytospermia

HSV:

Herpes simplex virus

CT:

Chlamyida trachomatis

UU:

Ureaplasma spp.

MH:

Mycoplasma hominis

MG:

Mycoplasma genitalium

NG:

Neisseria gonorrhoeae

Uuu:

Ureaplasma urealyticum

Uup:

Ureaplasma parvum

NGU:

Nongonoccocal urethritis

References

  1. World Health Organization. WHO laboratory manual for the examination and processing of human semen. 5th ed. Geneva: World Health Organization; 2010.

    Google Scholar 

  2. Micillo A, Vassallo MR, Cordeschi G, D’Andrea S, Necozione S, Francavilla F, Francavilla S, Barbonetti A. Semen leukocytes and oxidative-dependent DNA damage of spermatozoa in male partners of subfertile couples with no symptoms of genital tract infection. Andrology. 2016;4:808–15.

    Article  CAS  PubMed  Google Scholar 

  3. Khodamoradi K, Kuchakulla M, Narasimman M, Khosravizadeh Z, Ali A, Brackett N, Ibrahim E, Ramasamy R. Laboratory and clinical management of leukocytospermia and hematospermia: a review. Ther Adv Reprod Health. 2020;14:2633494120922511.

    PubMed  PubMed Central  Google Scholar 

  4. Kim SJ, Paik DJ, Lee JS, Lee HS, Seo JT, Jeong MS, Lee JH, Park DW, Han S, Lee YK, et al. Effects of infections with five sexually transmitted pathogens on sperm quality. Clin Exp Reprod Med. 2017;44:207–13.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Zhang QF, Zhang YJ, Wang S, Wei Y, Li F, Feng KJ. The effect of screening and treatment of Ureaplasma urealyticum infection on semen parameters in asymptomatic leukocytospermia: a case-control study. BMC Urol. 2020;20:165.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Farahani L, Tharakan T, Yap T, Ramsay JW, Jayasena CN, Minhas S. The semen microbiome and its impact on sperm function and male fertility: A systematic review and meta-analysis. Andrology. 2021;9:115–44.

    Article  CAS  PubMed  Google Scholar 

  7. Gimenes F, Souza RP, Bento JC, Teixeira JJ, Maria-Engler SS, Bonini MG, Consolaro ME. Male infertility: a public health issue caused by sexually transmitted pathogens. Nat Rev Urol. 2014;11:672–87.

    Article  PubMed  Google Scholar 

  8. Capoccia R, Greub G, Baud D. Ureaplasma urealyticum, Mycoplasma hominis and adverse pregnancy outcomes. Curr Opin Infect Dis. 2013;26:231–40.

    Article  PubMed  Google Scholar 

  9. Vallely LM, Egli-Gany D, Pomat W, Homer CS, Guy R, Wand H, Silver B, Rumbold AR, Kaldor JM, Low N, Vallely AJ. Adverse pregnancy and neonatal outcomes associated with Neisseria gonorrhoeae, Mycoplasma genitalium, M. hominis, Ureaplasma urealyticum and U. parvum: a systematic review and meta-analysis protocol. BMJ Open. 2018;8:e024175.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Beeton ML, Payne MS, Jones L. The Role of Ureaplasma spp. in the Development of Nongonococcal Urethritis and Infertility among Men. Clin Microbiol Rev 2019, 32.

  11. Xu C, Sun GF, Zhu YF, Wang YF. The correlation of Ureaplasma urealyticum infection with infertility. Andrologia. 1997;29:219–26.

    Article  CAS  PubMed  Google Scholar 

  12. Wang Y, Liang CL, Wu JQ, Xu C, Qin SX, Gao ES. Do Ureaplasma urealyticum infections in the genital tract affect semen quality? Asian J Androl. 2006;8:562–8.

    Article  PubMed  Google Scholar 

  13. Akgul A, Kadioglu A, Koksal MO, Ozmez A, Agacfidan A. Sexually transmitted agents and their association with leucocytospermia in infertility clinic patients. Andrologia. 2018;50:e13127.

    Article  PubMed  Google Scholar 

  14. Zhou YH, Ma HX, Shi XX, Liu Y. Ureaplasma spp. in male infertility and its relationship with semen quality and seminal plasma components. J Microbiol Immunol Infect. 2018;51:778–83.

    Article  PubMed  Google Scholar 

  15. Bezold G, Politch JA, Kiviat NB, Kuypers JM, Wolff H, Anderson DJ. Prevalence of sexually transmissible pathogens in semen from asymptomatic male infertility patients with and without leukocytospermia. Fertil Steril. 2007;87:1087–97.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Zhao N, Li KT, Gao YY, Xu JJ, Huang DS. Mycoplasma Genitalium and Mycoplasma Hominis are prevalent and correlated with HIV risk in MSM: a cross-sectional study in Shenyang, China. BMC Infect Dis. 2019;19:494.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Cottell E, Harrison RF, McCaffrey M, Walsh T, Mallon E, Barry-Kinsella C. Are seminal fluid microorganisms of significance or merely contaminants? Fertil Steril. 2000;74:465–70.

    Article  CAS  PubMed  Google Scholar 

  18. Gdoura R, Kchaou W, Znazen A, Chakroun N, Fourati M, Ammar-Keskes L, Hammami A. Screening for bacterial pathogens in semen samples from infertile men with and without leukocytospermia. Andrologia. 2008;40:209–18.

    Article  CAS  PubMed  Google Scholar 

  19. Ahmadi MH, Mirsalehian A, Bahador A. Prevalence of Urogenital Mycoplasmas in Iran and Their Effects on Fertility Potential: A Systematic Review and Meta-Analysis. Iran J Public Health. 2016;45:409–22.

    PubMed  PubMed Central  Google Scholar 

  20. Elsayed MS, Mahmoud El-Bagoury AE, Dawoud MA. Phenotypic and genotypic detection of virulence factors of Staphylococcus aureus isolated from clinical and subclinical mastitis in cattle and water buffaloes from different farms of Sadat City in Egypt. Vet World. 2015;8:1051–8.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Bos LD, de Jong MD, Sterk PJ, Schultz MJ. How integration of global omics-data could help preparing for pandemics - a scent of influenza. Front Genet. 2014;5:80.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Monavari SH, Vaziri MS, Khalili M, Shamsi-Shahrabadi M, Keyvani H, Mollaei H, Fazlalipour M. Asymptomatic seminal infection of herpes simplex virus: impact on male infertility. J Biomed Res. 2013;27:56–61.

    PubMed  Google Scholar 

  23. Ochsendorf FR. Sexually transmitted infections: impact on male fertility. Andrologia. 2008;40:72–5.

    Article  CAS  PubMed  Google Scholar 

  24. Neofytou E, Sourvinos G, Asmarianaki M, Spandidos DA, Makrigiannakis A. Prevalence of human herpes virus types 1–7 in the semen of men attending an infertility clinic and correlation with semen parameters. Fertil Steril. 2009;91:2487–94.

    Article  CAS  PubMed  Google Scholar 

  25. Kotronias D, Kapranos N. Detection of herpes simplex virus DNA in human spermatozoa by in situ hybridization technique. In Vivo. 1998;12:391–4.

    CAS  PubMed  Google Scholar 

  26. Senior K. Chlamydia: a much underestimated STI. Lancet Infect Dis. 2012;12:517–8.

    Article  PubMed  Google Scholar 

  27. Abusarah EA, Awwad ZM, Charvalos E, Shehabi AA. Molecular detection of potential sexually transmitted pathogens in semen and urine specimens of infertile and fertile males. Diagn Microbiol Infect Dis. 2013;77:283–6.

    Article  PubMed  Google Scholar 

  28. Boeri L, Pederzoli F, Capogrosso P, Abbate C, Alfano M, Mancini N, Clementi M, Montanari E, Montorsi F, Salonia A. Semen infections in men with primary infertility in the real-life setting. Fertil Steril. 2020;113:1174–82.

    Article  CAS  PubMed  Google Scholar 

  29. Gdoura R, Kchaou W, Chaari C, Znazen A, Keskes L, Rebai T, Hammami A. Ureaplasma urealyticum, Ureaplasma parvum, Mycoplasma hominis and Mycoplasma genitalium infections and semen quality of infertile men. BMC Infect Dis. 2007;7:129.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Koshiba H, Koshiba A, Daimon Y, Noguchi T, Iwasaku K, Kitawaki J. Hematoma and abscess formation caused by Mycoplasma hominis following cesarean section. Int J Womens Health. 2011;3:15–8.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Hakre S, Casimier RO, Danboise BA, Peel SA, Michael NL, Scott PT, Okulicz JF. Enhanced Sexually Transmitted Infection Screening for Mycoplasma genitalium in Human Immunodeficiency Virus -Infected US Air Force Personnel. Clin Infect Dis. 2017;65:1585–8.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Manhart LE, Gaydos CA, Taylor SN, Lillis RA, Hook EW 3rd, Klausner JD, Remillard CV, Love M, McKinney B, Getman DK. Characteristics of Mycoplasma genitalium Urogenital Infections in a Diverse Patient Sample from the United States: Results from the Aptima Mycoplasma genitalium Evaluation Study (AMES). J Clin Microbiol 2020, 58.

  33. Li WN, Shi L, Long XY, Li Y, Zhu WB, Liu G. Mycoplasma genitalium incidence, treatment failure, and resistance: a retrospective survey of men of infertile couples from a hospital in China. Andrology. 2020;8:91–100.

    Article  CAS  PubMed  Google Scholar 

  34. Kjaergaard N, Kristensen B, Hansen ES, Farholt S, Schonheyder HC, Uldbjerg N, Madsen H. Microbiology of semen specimens from males attending a fertility clinic. APMIS. 1997;105:566–70.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We are indebted to Xia Wu, Jingru Xu, Yin Zhu and Wei Cheng for their valuable contribution to the data collection.

Funding

This study was supported by National Natural Science Foundation of China (81901543, 81901545, 81971333, and 82001495), the National Key Research and Development Project (2019YFA0802600), the Fundamental Research Funds for the Central Universities (WK9110000063), State Key Laboratory of Reproductive Medicine (SKLRM-K201904), Natural Science Foundation of Anhui Provincial of China (1908085QH315).

Author information

Author notes

  1. Shun Bai, Yuan Li and Yangyang Wan contributed equally to the work.

Authors and Affiliations

  1. Reproductive and Genetic Hospital, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, P.R. China

    Shun Bai, Yangyang Wan, Tonghang Guo, Qi Jin, Ran Liu, Wenjuan Tang, Meiying Sang, Yuanyuan Tao, Yun Zhao, Wei Li, Xiangdong Xu & Bo Xu

  2. Dermatology Department, The Fifth People’s Hospital of Hainan Province, 570100, Haikou, Hainan, P.R. China

    Yuan Li

  3. Reproductive Medicine Center, the First Affiliated Hospital of Hainan Medical University, 570102, Haikou, Hainan, P.R. China

    Baoguo Xie

  4. Reproductive Medicine Center, The Affiliated Drum Tower Hospital of Nanjing University Medical School, 210008, Nanjing, Jiangsu, P.R. China

    Qiuling Yue

  5. Department of Urology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, P.R. China

    Xuechun Hu

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Contributions

SB designed the research study. YYW, THG, YZ, WL, XDX and SB contributed to the data acquisition. YL, QJ, RL, WJT, MYS, YYT, BGX, XCH, QLY and BX analyzed the data. SB wrote the paper. All of the authors approved the final manuscript.

Corresponding authors

Correspondence to Qiuling Yue, Xuechun Hu or Bo Xu.

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Ethics approval and consent to participate

This study was approved by The First Affiliated Hospital of USTC Ethical Committee. Written informed consent was obtained from all participants.

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Not applicable.

Competing interests

The authors declare no conflict of interest.

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Bai, S., Li, Y., Wan, Y. et al. Sexually transmitted infections and semen quality from subfertile men with and without leukocytospermia. Reprod Biol Endocrinol 19, 92 (2021). https://0-doi-org.brum.beds.ac.uk/10.1186/s12958-021-00769-2

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  • DOI: https://0-doi-org.brum.beds.ac.uk/10.1186/s12958-021-00769-2

Keywords

Reproductive Biology and Endocrinology

ISSN: 1477-7827

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