Sexually transmitted infections: impact on male fertility

Viral infection and its impact on fertility, medically assisted reproduction and early pregnancy - a narrative review

Viral infections can significantly affect the physiopathology of reproductive organs, leading to fertility problems, reducing the success rates of assisted reproductive technologies, and negatively impacting pregnancy. This review aims to summarize the current evidence on viral pathogens that are either suspected or confirmed to play a role in reproductive medicine and their effects on early pregnancy. For instance, viral hepatitis and human immunodeficiency virus can decrease sperm quality. Human papilloma virus infection in men appears to cause infertility, while herpesviruses pose a greater risk to fetuses rather than to fertility. The Zika virus disrupts early embryo development, necessitating a delay in conception for those suspected or confirmed to be infected. The effects of SARS-CoV-2 on reproduction are still unclear. Rubella and cytomegalovirus can cause serious congenital defects, making pre-conception screening essential, and a Rubella vaccine is recommended. More rigorous studies are needed to clarify the roles of various infectious agents, enhance fertility treatments, and improve pregnancy outcomes while reducing complications.

Rationale and Ethical Assessment of an Oropharyngeal Gonorrhea Controlled Human Infection Model

Infection with Neisseria gonorrhoeae, the causative agent of gonorrhea, causes significant morbidity worldwide and can have long-term impacts on reproductive health. The greatest global burden of gonorrhea occurs in low- and middle-income settings. Global public health significance is increasing due to rising antimicrobial resistance, which threatens future gonorrhea management. The oropharynx is an important asymptomatic reservoir for gonorrhea transmission and a high-risk site for development of antimicrobial resistance and treatment failure. Controlled human infection model (CHIM) studies using N gonorrhoeae may provide a means to accelerate the development of urgently needed therapeutics, vaccines, and other biomedical prevention strategies. A gonorrhea urethritis CHIM has been used since the 1980s with no reported serious adverse events. Here, we describe the rationale for an oropharyngeal gonorrhea CHIM, including analysis of potential ethical issues that should inform the development of this novel study design.

The consequences of climate change and male reproductive health: A review of the possible impact and mechanisms

A global decline in male fertility has been reported, and climate change is considered a major cause of this. Climate change refers to long-term shifts in temperatures and weather patterns, and results from greenhouse gas emissions like carbon dioxide and methane that act as a blanket wrapped around the earth, trapping heat and elevating temperatures. Sad to say, the consequences of climatic variation are beyond the dramatic elevated temperature, they include cold stress, increased malnutrition, air pollution, cardiovascular diseases respiratory tract infections, cancer, sexually transmitted infections, mental stress, and heat waves. These negative effects of climate change impair male reproductive function through multiple pathways, like ROS-sensitive signaling, suppression of steroidogenic markers, and direct damage to testicular cells. The present study aimed to describe the impact of the consequences of climate change on male reproductive health with details of the various mechanisms involved. This will provide an in-depth understanding of the pathophysiological and molecular basis of the possible climatic variation-induced decline in male fertility, which will aid in the development of preventive measures to abate the negative effects of climate change on male reproductive function.

Epidemiological characteristics of infertility, 1990-2021, and 15-year forecasts: an analysis based on the global burden of disease study 2021

BACKGROUND

Infertility, defined as the inability to achieve pregnancy after 1 year of regular unprotected intercourse, affects approximately 186 million people globally, with consistent prevalence across different income levels. Globally, the rising infertility rates are impacting population growth and individual quality of life. Infertility is not just a personal issue but also a public health concern, with social and economic implications, including stigmatization, marital discord, and mental strain. The COVID-19 pandemic has further exacerbated mental health issues among individuals with infertility, underscoring the need for research into the mental health impacts and access to fertility services. Economically, infertility poses a significant financial burden, especially in regions where Assisted Reproductive Technology (ART) costs can be up to 200% of the GDP per capita. Understanding the complexities and spread of infertility is essential for guiding policy decisions and program rollouts, with studies analyzing infertility issues based on the Global Burden of Disease (GBD) database.

METHODS

The study leverages data from the GBD 2021, encompassing 371 conditions or injuries and 88 risk factors across 204 nations. It examines prevalence, disability-adjusted life years (DALYs), age-standardized prevalence rate (ASPR), and age-standardized DALYs rate (ASDR) for infertility, categorized by sex, age, regions, and nations. The Social and Demographic Index (SDI), reflecting socio-economic levels, is used to analyze its correlation with infertility burden. The study employs decomposition analysis and frontier analysis methods to assess changes in infertility prevalence and DALYs, and Spearman's rank correlation coefficient to confirm relationships between age-standardized rates (ASRs) and SDI. The estimated annual percentage change (EAPC) of rates, with 95% confidence intervals (CIs), was calculated.

RESULTS

In 2021, it was calculated that the global ASPR for male infertility stood at 1354.76 cases per 100,000 individuals, with a 95% Uncertainty Interval ranging from 802.12 to 2174.77 cases per 100,000 individuals. For female infertility, the ASPR was recorded at 2764.62 per 100,000 individuals (95% UI: 1476.33-4862.57 per 100,000 individuals). Between 1990 and 2021, the EAPC in ASPR was observed to be 0.5% (95% CI 0.36-0.64) for males and 0.7% (95% CI 0.53-0.87) for females. In that same year, the global ASDR attributed to male infertility was 7.84 per 100,000 individuals (95% UI: 2.85-18.56 per 100,000 individuals), while for female infertility, it amounted to 15.12 per 100,000 individuals (95% UI: 5.35-36.88 per 100,000 individuals). The EAPC for ASDR linked to male and female infertility from 1990 to 2021 was assessed at 0.51% (95% CI 0.38-0.65) and 0.71% (95% CI 0.54-0.88), respectively. Among the 204 countries and territories in 2021, India ranked first in both the prevalence of cases and DALYs associated with male and female infertility, followed by China and Indonesia. Additionally, the investigation revealed a slight negative correlation between the ASPR and ASDR of infertility and the SDI. Decomposition analysis indicated that approximately 65% of the rise in the global burden of infertility could be attributed to population growth. Frontier analysis suggested that the variations in efficiency frontiers across specific SDI levels diminish as the SDI increases. Looking forward, the study projects a global rise in ASPR and ASDR for infertility between 2022 and 2036.

CONCLUSIONS

The worldwide prevalence of infertility has substantially increased between 1990 and 2021, largely as a result of population growth. This trend highlights the pressing necessity for better strategies concerning prevention, diagnosis, and treatment, particularly in low and middle-income nations. Strengthening healthcare infrastructures, enhancing access to high-quality medical services, and raising awareness about infertility are vital measures to tackle this issue. The results of the study offer essential information to help policymakers and health officials formulate targeted strategies for the prevention and management of infertility.

Sexual self-care, quality of sexual life and fertility desire in women attending comprehensive health centers in Urmia, Iran

BACKGROUND

Sexual self-care and quality of sexual life are critical factors in women's health. These factors can also influence women's fertility desire. This study aims to examine sexual self-care, quality of sexual life, and their relationship with fertility desire in women attending comprehensive health centers in Urmia.

METHODS

This descriptive-analytical study was conducted on 384 women which were randomly selected using a multistage sampling method. Data were collected using standard validity and reliability questionnaires of sexual self-care, quality of sexual life and fertility desire. Data were analyzed using one-way ANOVA, independent t-test, and multiple regression.

RESULTS

The average age of the participants was 32.92 ± 8.03 years. Women's education level and economic status were significantly associated with fertility desire (P < 0.05). Additionally, sexual self-care (B = 0.490,p < 0.001) and the quality of sexual life (B = 0.232,p < 0.001) were strong predictors of fertility desire. Together, they accounted for 92.8% of the variance in total fertility desire scores.

CONCLUSION

Sexual self-care and the quality of women's sexual life are directly related to the fertility desire. Therefore, Participating in training workshops on body anatomy, menstrual cycle and sexual self-care techniques, providing private counseling sessions to investigate sexual concerns and problems, and providing suitable solutions will help women's fertility desire.

The possible pathogenic mechanisms of microorganisms in infertility: a narrative review

Infertility can harm a patient in physical, psychological, spiritual, and medical ways. This illness is unusual because it affects the patient's companion and the patient individually. Infertility is a multifactorial disease, and various etiological factors like infection are known to develop this disorder. Recently published studies reported that different bacteria, such as Chlamydia trachomatis, Mycoplasma spp., Ureaplasma urealyticum, Escherichia coli, Staphylococcus aureus, and Pseudomonas aeruginosa, can lead to infertility by immunopathological effects, oxidative stress, and adverse effects on sperm concentration, motility, morphology, and DNA condensation. Among viruses, Human papillomavirus and Herpes simplex virus reduce sperm progressive motility and sperm concentration. The viruses can lead to the atrophy of the germinal epithelium and degenerative changes in the testes. Candida albicans also harm sperm quality, motility, and chromatin integrity and induce apoptosis in sperm cells. Finally, Trichomonas vaginalis leads to distorted heads, broken necks, and acrosomes exocytosis in sperms. This parasite decreases sperm viability and functional integrity. Noteworthy, oxidative stress could have a role in many pathological changes in the reproductive system. Recent findings show that microorganisms can increase reactive oxygen species concentration inside the host cells, leading to oxidative stress and sperm distress and dysfunction. Therefore, this article explores the potential significance of critical bacteria linked to infertility and their pathogenic mechanisms that can affect sperm function and the female reproductive system.

Gonorrhea cluster detection in Manitoba, Canada: Spatial, temporal, and spatio-temporal analysis

In Canada, Gonorrhea infection ranks as the second most prevalent sexually transmitted infection. In 2018, Manitoba reported an incidence rate three times greater than the national average. This study aims to investigate the spatial, temporal, and spatio-temporal patterns of Gonorrhea infection in Manitoba, using individual-level laboratory-confirmed administrative data provided by Manitoba Health from 2000 to 2016. Age and sex patterns indicate that females are affected by infections at younger ages compared to males. Moreover, there is an increase in repeated infections in 2016, accounting for 16% of the total infections. Spatial analysis at the 96 Manitoba regional health authority districts highlights significant positive spatial autocorrelation, demonstrating a clustered distribution of the infection. Northern districts of Manitoba and central Winnipeg were identified as significant clusters. Temporal analysis shows seasonal patterns, with higher infections in late summer and fall. Additionally, spatio-temporal analysis reveals clusters during high-risk periods, with the most likely cluster in the northern districts of Manitoba from January 2006 to June 2014, and a secondary cluster in central Winnipeg from June 2004 to November 2012. This study identifies that Gonorrhea infection transmission in Manitoba has temporal, spatial, and spatio-temporal variations. The findings provide vital insights for public health and Manitoba Health by revealing high-risk clusters and emphasizing the need for focused and localized prevention, control measures, and resource allocation.

Epidemiology of gonorrhea in countries of the Middle East and North Africa: systematic review, meta analyses, and meta regressions

BACKGROUND

The epidemiology of Neisseria gonorrhoeae (NG) infection in the Middle East and North Africa (MENA) region remains poorly understood, despite the global recognition of its disease burden and the growing concern regarding antimicrobial resistance. This study aimed to systematically review the evidence on NG prevalence in MENA, estimate the pooled mean prevalence across different populations, and explore population-level associations with prevalence as well as sources of between-study heterogeneity.

METHODS

The study conducted a systematic review, risk of bias assessment, meta-analyses, and meta-regressions, utilizing both published and unpublished evidence sourced from international, regional, and national databases, in adherence to PRISMA guidelines. Random-effects meta-analyses and meta-regressions were employed to analyze the data.

RESULTS

The study identified 341 NG prevalence measures from 21 countries in MENA. The pooled mean prevalence of current urogenital infection was 1.9% (95% confidence interval (CI) 1.1-2.8%) in the general population, with a higher pooled prevalence in studies with sample sizes < 200 (3.1%; 95% CI 1.5-5.0%) compared to those with sample sizes ≥ 200 (1.1%; 95% CI 0.5-1.9%). Among specific populations, the pooled prevalence was 6.5% (95% CI 4.4-9.0%) in female sex workers, 7.5% (95% CI 2.8-14.0%) in attendees of infertility clinics, 3.0% (95% CI 0.4-7.0%) in women with miscarriage or ectopic pregnancy, 3.9% (95% CI 2.7-5.3%) in symptomatic women, and 41.4% (95% CI 34.9-48.1%) in symptomatic men. For male sex workers and men who have sex with men, the pooled prevalence of current urogenital infection was 1.6% (95% CI 0.4-3.4%), while the prevalence of current anorectal infection was 10.4% (95% CI 4.6-18.0%). Through multivariable meta-regressions, 64% of the prevalence variation was explained, revealing a hierarchical pattern in prevalence by population type and sex, and a prevalence decline at a rate of 1% per year.

CONCLUSIONS

NG prevalence in MENA is comparable to the global prevalence, underscoring a neglected and underrecognized disease burden, with social and economic consequences. Persistent transmission of NG among key populations and other populations at risk increases the potential for the emergence of new drug-resistant strains. MENA is far from achieving the World Health Organization's target of reducing NG incidence by 90% by 2030.

Elucidating the Transcriptional States of Spermatogenesis-Joint Analysis of Germline and Supporting Cell, Mice and Human, Normal and Perturbed, Bulk and Single-Cell RNA-Seq

In studying the molecular underpinning of spermatogenesis, we expect to understand the fundamental biological processes better and potentially identify genes that may lead to novel diagnostic and therapeutic strategies toward precision medicine in male infertility. In this review, we emphasized our perspective that the path forward necessitates integrative studies that rely on complementary approaches and types of data. To comprehensively analyze spermatogenesis, this review proposes four axes of integration. First, spanning the analysis of spermatogenesis in the healthy state alongside pathologies. Second, the experimental analysis of model systems (in which we can deploy treatments and perturbations) alongside human data. Third, the phenotype is measured alongside its underlying molecular profiles using known markers augmented with unbiased profiles. Finally, the testicular cells are studied as ecosystems, analyzing the germ cells alongside the states observed in the supporting somatic cells. Recently, the study of spermatogenesis has been advancing using single-cell RNA sequencing, where scientists have uncovered the unique stages of germ cell development in mice, revealing new regulators of spermatogenesis and previously unknown cell subtypes in the testis. An in-depth analysis of meiotic and postmeiotic stages led to the discovery of marker genes for spermatogonia, Sertoli and Leydig cells and further elucidated all the other germline and somatic cells in the testis microenvironment in normal and pathogenic conditions. The outcome of an integrative analysis of spermatogenesis using advanced molecular profiling technologies such as scRNA-seq has already propelled our biological understanding, with additional studies expected to have clinical implications for the study of male fertility. By uncovering new genes and pathways involved in abnormal spermatogenesis, we may gain insights into subfertility or sterility.

Neisseria gonorrhoeae vaccines: a contemporary overview

Neisseria gonorrhoeae infection is an important public health issue, with an annual global incidence of 87 million. N. gonorrhoeae infection causes significant morbidity and can have serious long-term impacts on reproductive and neonatal health and may rarely cause life-threatening disease. Global rates of N. gonorrhoeae infection have increased over the past 20 years. Importantly, rates of antimicrobial resistance to key antimicrobials also continue to increase, with the United States Centers for Disease Control and Prevention identifying drug-resistant N. gonorrhoeae as an urgent threat to public health. This review summarizes the current evidence for N. gonorrhoeae vaccines, including historical clinical trials, key N. gonorrhoeae vaccine preclinical studies, and studies of the impact of Neisseria meningitidis vaccines on N. gonorrhoeae infection. A comprehensive survey of potential vaccine antigens, including those identified through traditional vaccine immunogenicity approaches, as well as those identified using more contemporary reverse vaccinology approaches, are also described. Finally, the potential epidemiological impacts of a N. gonorrhoeae vaccine and research priorities for further vaccine development are described.

Molecular study of the presence and transcriptional activity of HPV in semen

PURPOSE

Human Papillomavirus (HPV) in semen represents a controversial topic. Recent evidence suggests a correlation with poor semen quality, but its detection is still unstandardized in this biological fluid. Thus, the aims of this study were to verify the ability of nested PCR to reveal HPV-DNA in semen; to evaluate association of seminal HPV with sperm parameters and risk factors for infection; to investigate the rate of HPV-DNA positivity in patients with and without risk factors; to assess HPV transcriptional activity.

METHODS

We enrolled sexually active men and collected clinical and anamnestic data during andrological and sexually transmitted infections (STIs) evaluation. For each patient, we performed semen analysis and nested PCR to detect HPV-DNA in semen. In positive semen samples, we proceeded with genotyping and RNA quantification to detect HPV transcriptional activity.

RESULTS

We enrolled 185 men (36.0 ± 8.3 years), of which 85 with (Group A) and 100 without HPV risk factors (Group B). Nested PCR was able to reveal HPV-DNA in semen, discovering a prevalence of 8.6% (11.8% in Group A and 6% in Group B, respectively). We observed no correlation between sperm quality and seminal HPV. Genital warts and previous anogenital infection were significantly associated with the risk of HPV positivity in semen. Moreover, no viral transcriptional activity was detected in positive semen samples.

CONCLUSIONS

Our study suggests that searching for seminal HPV could be important in patients both with and without risk factors, especially in assisted reproduction where the risk of injecting sperm carrying HPV-DNA is possible.

Knowledge, attitude, and practice of infertility: a comparative study in infertile and fertile Indian women

For women who are trying to conceive, it is critical to assess their general knowledge regarding fertility and fertility-awareness practices to identify the fertile window and their agency to achieve pregnancy. The couple's ability to deal with the infertility issue may be influenced by their beliefs and attitudes concerning infertility, which are based on social and cultural influences as well as their inner aspirations. As a result, it's critical to examine infertile and fertile woman's general knowledge of reproduction and infertility risk factors. It's also crucial to learn about women's attitudes toward infertility (social beliefs), as well as the repercussions of infertility and the practises they employ to avoid it. The present study includes 250 fertile and 250 infertile women. Data collection for infertile women was done from the Gynecology Outpatient Department (OPD). Participants from both groups i.e., infertile and fertile women have little knowledge about infertility but, infertile women have significantly higher knowledge than fertile women. Knowledge of the fertile period, as well as several potential causes of infertility, were found to be significantly higher in women with infertility problem rather than fertile women, indicating that the knowledge they have acquired is not attributable to education system, but rather to their experience gained during visits to medical practitioners. In addition to differences with respect to knowledge, infertile and fertile women differed in terms of both attitude (societal beliefs and social consequences of infertility) and practices. Better knowledge regarding infertility is likely to bring positive notes among women with infertility problems. Which will further improve the attitude and practices of society towards infertile women. Therefore, its crucial to introduce reproductive health education at high school or undergraduate level, to assist women in avoiding infertility and to help infertile women develop healthier attitudes regarding infertility treatment and coping techniques.

Viruses, bacteria and parasites: infection of the male genital tract and fertility

BACKGROUND

Infertility affects one couple out of six worldwide. Male infertilty can result from congenital or acquired factors, of which pathogens that reach the genital tract through sexual contact or blood dissemination. The impact of major viral, bacterial and parasitic infections on the male genital tract and fertility has been summarized.

RESULTS AND CONCLUSIONS

A systematic review of articles published in the Google Scholar and PubMed databases was conducted. It turns out that viruses, as well as bacteria and parasites are major inducers of male genital tract infections and ensuing infertility through damage to the organs and subsequent loss of function and/or through direct damage to the sperm cells. Moreover, not only male infertility results from such infections but these can also be transmitted to women and even to the offspring, thus highlighting the need to efficiently detect, treat and prevent them.

Are sexually transmitted infections associated with male infertility? A systematic review and in-depth evaluation of the evidence and mechanisms of action of 11 pathogens

Purpose

To systematically review the evidence on the association between sexually transmitted infections (STIs) and male infertility. We sought to answer two questions: Are STIs significantly associated with detrimental changes in semen parameters?; and, is the prevalence of STIs significantly higher in infertile than fertile men?

Materials and methods

PubMed, Scopus and Google Scholar databases were searched (inceptionMarch 2023) following the PRISMA guidelines. Identified original studies in English on the association between STIs and male infertility were included. Data was tabulated/described by pathogen, mechanisms of action, number of studies and their level of evidence.

Results

Seventy out of 903 originally retrieved articles were included in this review. For the detrimental changes in semen parameters (first question), the evidence seems equivocal based on the nearly equal number of studies and similar levels of evidence. The only exception was for Ureaplasma, where the number of studies and levels of evidence supported an association with male infertility. Pertaining to a significantly higher prevalence of STI among infertile compared to fertile men (second question), evidence was insufficient to support/deny a significant association. The two exceptions were Ureaplasma and Mycoplasma, where the number of studies and evidence levels were in favour of an association with male infertility.

Conclusions

Generally, the relationship between STIs and male infertility remains to be uncovered. Our appraisal of the overall state of this relationship shows that the evidence base leaves much to be desired. The exceptions are Ureaplasma and Mycoplasma, where the evidence convincingly suggests their associations with infertility in men.

Seminal plasma testis expressed sequence (TEX)-101 as a biomarker for the qualitative assessment of male factor infertility: A case-control study

OBJECTIVE

The study was conducted to assess the role of seminal plasma Testis Expressed Sequence (TEX)-101 as a biomarker of male infertility.

STUDY DESIGN

The study was conducted on 180 men (20-50 years) with 90 having abnormal semen reports as cases and 90 with normal reports as controls in a rural tertiary care center in Southern India over two years. After the enrolment of cases and control, semen samples were cryopreserved till the desired sample size was achieved and a biochemical test for TEX-101 was run using Human Testis-expressed Protein 101 ELISA Kit. The results of TEX-101 were compared between cases and controls and correlated with various semen parameters. Statistical analysis was done using SPSS software version 22.0, a p-value < 0.05 was considered statistically significant.

RESULTS

Mean ± SD age of all participants was 29.94 ± 4.91 years. Of 90 cases, 48.9% had asthenospermia, 24.4% oligoasthenospermia, 15.6% oligospermia, 11.1% azoospermia. A statistically significant difference was observed in mean values of seminal plasma TEX-101 between cases (1.45 ± 0.08 ng/mL) and controls (2.26 ± 0.18 ng/mL), p = 0.001. A significant correlation (p = 0.001) was found between seminal TEX-101, semen volume, sperm concentration, progressive motility, and morphology. The area under the Receiver Operating Characteristic curve of TEX-101 between cases and controls was 1.00 (p = 0.001), indicating TEX-101 as a potential biomarker for distinguishing men with abnormal semen parameters from those with normal semen parameters. At a cut-off value of 1.84 ng/mL, seminal plasma TEX-101 had a sensitivity, specificity, and negative and positive predictive values of 100% for male infertility prediction.

CONCLUSION

Seminal TEX-101 is a potential seminal biomarker and can be used in the qualitative assessment of male factor infertility.

Semen human papillomavirus (HPV) shedding in males: frequency, clinical significance, and reproductive outcomes—literature review

Background

The interest in the HPV status of the male has risen after the discovery of HPV shedding in the semen. To date, there is no consensus on the true prevalence of male HPV infection, yet there is a rising body of evidence suggesting that male HPV infection might negatively affect the sperm parameters.

Main body

The concern that HPV can lead to a couple’s infertility and affect reproductive outcomes had increased after the multiple publications of semen criteria perturbations specifically the asthenospermia associated with HPV infection. An extensive literature review was performed to define the actual frequency of male HPV infection as well as the true extent of sperm analysis perturbations related to the HPV illness. We also intended to define the impact of these infections on reproductive outcomes and to highlight any treatment plans for affected couples.

Conclusion

HPV is a prevalent disease with a rising concern among the male populations given the suggested impact on sperm motility as well as the pregnancy and miscarriage rates post-ART treatment. Vaccines are being studied now as a possible infertility adjunct treatment for males who are already infected.

Human seminal virome: a panel based on recent literature

Background

The seminal virome and its implications for fertility remain poorly understood. To date, there are no defined panels for the detection of viruses of clinical interest in seminal samples.

Results

In this study, we characterized the human seminal virome based on more than 1,000 studies published over the last five years.

Conclusions

The number of studies investigating viruses that occur in human semen has increased, and to date, these studies have been mostly prospective or related to specific clinical findings. Through the joint analysis of all these studies, we have listed the viruses related to the worsening of seminal parameters and propose a new panel with the main viruses already described that possibly affect male fertility and health. This panel can assist in evaluating semen quality and serve as a tool for investigation in cases of infertility.

Associations between Awareness of Sexually Transmitted Infections (STIs) and Prevalence of STIs among Sub-Saharan African Men and Women

Treatments for HIV and other STIs are not readily available in sub-Saharan Africa and other resource-limited areas, where the prevalence of HIV and other STIs is high. In the absence of treatment and laboratory infrastructure to monitor treatment efficacy, increasing awareness of STIs and STI screening are crucial components of STI prevention programs. In the current study, we sought to estimate the awareness of STIs in resource-limited countries and evaluate the strength of the association between the awareness of STIs and STIs infection. We did a secondary analysis of data obtained from 2019 women and 794 men enrolled in a community-based study that was conducted from November 2002 to March 2003 in the Moshi Urban District of Northern Tanzania. We found gonorrhea, syphilis, and HIV/AIDS were well-known among the study participants. However, their awareness of other STIs, including herpes, was very low. We also found that the awareness of STIs was not associated with STIs in men, but women who had prior knowledge of gonorrhea, syphilis, and HIV had a twofold higher risk of testing positive for an STI. Education programs aimed at increasing awareness of STIs are needed in the region. The majority of the existing STI education programs in the region focus exclusively on HIV/AIDS. The expansion of the existing AIDS/HIV education programs needs to be strengthened to include information about other STIs.

Knowledge of the Health Implications of Oral Sex among Registered Nurses in Nigeria: An Online Pilot Study

Introduction Oral sex is a pleasurable act that has its health implications, particularly sexually transmitted oral infections. In Nigeria, nurses constitute one of the at-risk population groups due to reports of risky sexual behavior among them. This study seeks to investigate the knowledge of nurses in Nigeria on the health implications of oral sex.

Methods This study was a survey of a pilot volunteer sample (n = 129) of registered nurses in Nigeria. The study tool was an anonymous questionnaire that was circulated electronically to nurses via social media platforms. Data collected was analyzed using the SPSS Version 20 software (IBM Corp, New York, New York, United States).

Results The majority (90.7%) of the 129 respondents had received training on oral health, 49.6% had engaged in oral sex before, and 58.1% were willing to engage in oral sex in future. History of previous oral health training was the only background characteristic found to be statistically significantly associated with the knowledge of oral sex-related health implications among nurses (p-value = 0.004); other characteristics (such as gender, age, and marital status) were not statistically significant (p-values >0.05). From multivariate analysis, history of oral health training was also found to be a statistically significant predictor of such knowledge (p-value = 0.015).

Conclusion Oral health knowledge is a significant determinant of the knowledge of oral sex-related health implications. This study also provides the preliminary evidence that forms the base on which further research should be conducted in this area.

Bacteriospermia and Male Infertility: Role of Oxidative Stress

Male infertility is one of the major challenging and prevalent diseases having diverse etiologies of which bacteriospermia play a significant role. It has been estimated that approximately 15% of all infertility cases are due to infections caused by uropathogens and in most of the cases bacteria are involved in infection and inflammation leading to the development of bacteriospermia. In response to bacterial load, excess infiltration of leukocytes in the urogenital tract occurs and concomitantly generates oxidative stress (OS). Bacteria may induce infertility either by directly interacting with sperm or by generating reactive oxygen species (ROS) and impair sperm parameters such as motility, volume, capacitation, hyperactivation. They may also induce apoptosis leading to sperm death. Acute bacteriospermia is related with another clinical condition called leukocytospermia and both compromise male fertility potential by OS-mediated damage to sperm leading to male infertility. However, bacteriospermia as a clinical condition as well as the mechanism of action remains poorly understood, necessitating further research in order to understand the role of individual bacterial species and their impact in male infertility.

First characterisation of antimicrobial susceptibility and resistance of Neisseria gonorrhoeae isolates in Qatar, 2017-2020

Limited data are available regarding antimicrobial resistance in Neisseria gonorrhoeae strains circulating in WHO Eastern Mediterranean Region (EMR). We investigated the antimicrobial susceptibility/resistance of N. gonorrhoeae isolates to five antimicrobials (ceftriaxone, azithromycin, ciprofloxacin, tetracycline, and benzylpenicillin) currently or previously used for gonorrhoea treatment in Qatar, 2017–2020. Minimum inhibitory concentrations (MICs; mg/L) of antimicrobials were determined using Etest on gonococcal isolates collected during January 1, 2017-August 30, 2020 at Hamad Medical Corporation, a national public healthcare provider. During 2017–2020, resistance in isolates from urogenital sites of 433 patients was 64.7% (95% CI: 59.5–69.6%; range: 43.9–78.7%) for ciprofloxacin, 50.7% (95% CI: 45.3–56.1%; range: 41.3–70.4%) for tetracycline, and 30.8% (95% CI: 26.3–35.6%; range: 26.7–35.8%) for benzylpenicillin. Percentage of isolates non-susceptible to azithromycin was 4.1% (95% CI: 2.0–7.4%; range: 2.7–4.8%) and all (100%) isolates were susceptible to ceftriaxone. Two (1.6%) isolates from 2019 and one (2.2%) isolate from 2020 had high-level resistance to azithromycin (MIC≥256 mg/L). Overall, 1.0% (4/418) of isolates had a ceftriaxone MIC of 0.25 mg/L, which is at the ceftriaxone susceptibility breakpoint (MIC≤0.25 mg/L). Treatment with ceftriaxone 250 mg plus azithromycin 1 g can continuously be recommended for gonorrhoea therapy in Qatar. Continued quality-assured gonococcal AMR surveillance is warranted in EMR.

Stem cells technology as a platform for generating reproductive system organoids and treatment of infertility-related diseases

In recent years, stem cells have known as a helpful biological tool for the accurate diagnosis, treatment and recognition of diseases. Using stem cells as biomarkers have presented high potential in the early detection of many diseases. Another advancement in stem cell technology includes stem cell derived organoids model that could be a promising platform for diagnosis and modeling different diseases. Furthermore, therapeutic capabilities of stem cell therapy have increased hope in the face of different disability managements. All of these technologies are also widely used in reproductive related diseases especially in today's world that many couples encounter infertility problems. However, with the aid of numerous improvements in the treatment of infertility, over 80% of couples who dreamed of having children could now have children. Due to the fact that infertility has many negative effects on personal and social lives of young couples, many researchers have focused on the treatment of male and female reproductive system abnormalities with different types of stem cells, including embryonic stem cells, bone marrow mesenchymal stem cells (MSCs), and umbilical cord-derived MSCs. Also, design and formation of reproductive system organoids provide a fascinating window into disease modeling, drug screening, personalized therapy, and regeneration medicine. Utilizing these techniques to study, model and treat the infertility-related diseases has drawn attention of many scientists. This review explains different applications of stem cells in generating reproductive system organoids and stem cell-based therapies for male and female infertility related diseases treatment.

Viral Infections and Male Infertility: A Comprehensive Review of the Role of Oxidative Stress

Viral infections have been a part of human existence to date, though viruses have posed a huge threat with various outbreaks lately. These threats are associated with reproductive health challenges, especially male infertility. The prime focus of this review is to highlight the mechanisms associated with viral infection-induced male infertility/subfertility and identify new treatment strategies with the aim to preserve male fertility. The reviewed data showed that viral infections stimulate inflammatory responses, resulting in the release of proinflammatory cytokines, which induces oxidative stress. This oxido-inflammatory cycle could continue in a vicious cycle and threaten male fertility. Existing data from human and experimental studies show that viral infection-induced oxido-inflammatory response results in testicular damage, atrophy of the seminiferous tubules and Sertoli cells, and reduced Leydig cell mass. This is accompanied by reduced circulatory testosterone, impaired spermatogenesis, reduced sperm motility, lipid peroxidation, DNA fragmentation and apoptosis of the sperm cells. Based on the available pieces of evidence, antioxidant therapy, in vivo and in vitro, may be beneficial and protects against the potential risk of male infertility from viral infection. It is, however recommended that more clinical studies be conducted to demonstrate the possible protective roles of antioxidants used as adjuvant therapy in viral infections, and in the in vitro treatment of semen samples for those utilizing semen washing and artificial reproductive techniques.

Mycoplasma genitalium Provokes Seminal Inflammation among Infertile Males

The impact of sexually transmitted infections (STI) on male fertility is controversial. Aims: To investigate the prevalence of urethritis-associated STIs (chlamydia, gonorrhoeae, Mycoplasma genitalium, trichomoniasis) among infertile males; to analyze the effect of STIs on semen parameters and blood PSA. Case-control study. Study group (n = 2000): males with fertility problems or desire for fertility check. Control group (n = 248): male partners of pregnant women. Analyses: polymerase chain reaction for STI, seminal interleukin 6 (IL-6), semen and fractionated urine, blood analyses (PSA, reproductive hormones). The prevalence of M. genitalium and chlamydia in the study group was 1.1% and 1.2%, respectively. The prevalence of chlamydia in the control group was 1.6%, while there were no M. genitalium cases. No cases with gonorrhoeae or trichomoniasis or combined infections were observed in neither group. There was a higher seminal concentration of neutrophils and IL-6 among M. genitalium positives compared with STI negatives. There was a trend toward a lower total count of spermatozoa and progressive motility among STI positives. No impact of STIs on PSA was found. The prevalence of STIs among infertile males is low. M. genitalium is associated with seminal inflammation. The impact of STIs on semen parameters deserves further investigations.

The Impact of Pediatric Rheumatic Diseases on Sexual Health, Family Planning, and Pregnancy

A comprehensive review of reproductive health subtopics, including sexual intercourse, romantic relationships, contraception, sexually transmitted infections, pregnancy, and infertility, as they pertain to patients with pediatric rheumatic diseases and those who care for them.

Bacterial Infections Affect Male Fertility: A Focus on the Oxidative Stress-Autophagy Axis

Numerous factors trigger male infertility, including lifestyle, the environment, health, medical resources and pathogenic microorganism infections. Bacterial infections of the male reproductive system can cause various reproductive diseases. Several male reproductive organs, such as the testicles, have unique immune functions that protect the germ cells from damage. In the reproductive system, immune cells can recognize the pathogen-associated molecular patterns carried by pathogenic microorganisms and activate the host's innate immune response. Furthermore, bacterial infections can lead to oxidative stress through multiple signaling pathways. Many studies have revealed that oxidative stress serves dual functions: moderate oxidative stress can help clear the invaders and maintain sperm motility, but excessive oxidative stress will induce host damage. Additionally, oxidative stress is always accompanied by autophagy which can also help maintain host homeostasis. Male reproductive system homeostasis disequilibrium can cause inflammation of the genitourinary system, influence spermatogenesis, and even lead to infertility. Here, we focus on the effect of oxidative stress and autophagy on bacterial infection in the male reproductive system, and we also explore the crosslink between oxidative stress and autophagy during this process.

Microbiota of semen samples with normozoospermia: analysis of real-time PCR data

The analysis of semen microbiota is difficult due to the lack of established criteria for interpretation of microbiological tests. The aim of the study was to determine the stable clusters of semen microbiota analyzed by real-time PCR in samples with normozoospermia. Semen samples of 227 men with normal spermiograms were included in the study. The quantity of total bacterial DNA and at least one group of microorganisms was more than 103 GE/ml in 107 (41.7%) samples. Four stable microbiota clusters with the prevalence of a specific microorganism group were distinguished in these samples: obligate anaerobes (OA) cluster (proportion in the centroid — 81.1%); Lactobacillus spp. cluster (proportion in the centroid — 64.3%); gram-positive facultative anaerobes (GPFA) cluster (proportion in the centroid — 92.5%); Enterobacteriaceae/Enterococcoccus (EE) cluster (proportion in the centroid — 80.8%). The clusters were ranked by frequency of occurrence: OA cluster was the most prevalent (43 (40.2%) of 107), second-most frequent were GPFA-cluster (27 (25.2%)) and Lactobacillus-cluster (22 (20.6%)). EE-dominated cluster was found in 15 (14.0%) cases.

Relative frequency of hepatitis B virus, human papilloma virus, Epstein-Barr virus, and herpes simplex viruses in the semen of fertile and infertile men in Shiraz, Iran: A cross-sectional study

Background

About 8-12% of couples on reproductive age suffers from infertility worldwide. Since 1993, the role of genital tract infections by microbes, including viruses that can infect the sperm, in human infertility has been proposed.

Objective

To investigate the frequency of hepatitis B virus (HBV), human papilloma virus (HPV), Epstein-Barr virus (EBV), and herpes simplex virus (HSV) infection in the semen of fertile and infertile men referred to the Mother and Child Hospital, Shiraz, Iran.

Materials and Methods

In this cross-sectional study, 350 men including 200 infertile and 150 fertile men were included. All semen samples were allowed to liquefy, followed by the assessment of sperm parameters. DNA was extracted using a DNA extraction kit (CinaGene, Tehran, Iran) according to the manufacturer's instructions. Detection of HBV, HPV, EBV, and HSV1/2 was done by the PCR method.

Results

The mean age of the participants was 36 ± 7 yr. Molecular results showed that 16 samples (8%) of infertile men and 5 (3.3%) of fertile men were positive for HBV, which was not statistically significant (p = 0.069). Only one sample of the fertile participants was positive for HPV. None of the semen samples of the infertile or fertile groups was positive for the presence of EBV or HSV1/2.

Conclusion

The results of this study indicated that HBV, HPV, EBV, and HSV might not be involved in men's infertility. Further studies are recommended for clarifying the role of these viruses in infertility.

Association of Herpes simplex virus I&II infections with rs187084 SNP of TLR9 and male infertility

Since TLR9 recognises unmethylated CpG motifs in viral DNA, its polymorphisms may contribute to the susceptibility to Herpes simplex virus I&II infection. In the present study, to evaluate the role of rs187084 SNP (single nucleotide polymorphism) of TLR9 in Herpes simplex virus I&II infection and male infertility, 103 infertile and 27 fertile blood and semen samples were analysed. We assessed the micro and macro properties of semen specimens and the presence of HSV immunoglobulins. Tetra-primer ARMS PCR was used to detect SNP and to investigate the genotype distribution of TLR9-rs187084 SNPs, and the correlation between polymorphisms of TLR9 gene and male infertility. Moreover, the odds ratio (OR) and 95% confidence intervals were used to estimate the strength of the association. Based on our finding, a significant correlation was observed between HSV infection, agglutination and polymorphism (TT) under dominant (OR = 1.28, 95% CI = 0.94-1.75) and recessive (OR = 0.44, 95% CI = 0.21-0.94) models for the data, which was complied with Hardy-Weinberg equilibrium (HWE) (OR = 2.91, 95% CI = 1.02-8.30). The result showed a significant association between HSV IgM and agglutination in HSV infection (p < .001), and in addition, there were associations between alleles so that rs187084 SNP might be considered as a risk factor for the incidence of HSV infection.

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

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.

Effect of lactoferrin on murine sperm apoptosis induced by intraperitoneal injection of lipopolysaccharide

Genital bacterial infection is one of the most important causes of infertility, however, bacteria frequently exist in seminal fluid. Sperm express Toll-like receptors (TLRs) on their cell surfaces and bacterial recognition by TLRs induces sperm apoptosis. In this study, we examined the lactoferrin (LF) potentiality on sperm apoptosis induced by bacterial lipopolysaccharide (LPS). The TdT-mediated dUTP-biotin nick end labeling (TUNEL) assay indicated that TUNEL-positive sperm cells were scarce in the group treated with LF and LPS (LF/LPS group) compared to the group treated with LPS only (LPS group). In addition, real-time RT-PCR detected lower mRNA expression levels of apoptosis-associated genes in the LF/LPS group compared to the LPS group. These results indicate that LF treatment of semen might decrease LPS-induced apoptosis of sperm.

Effect of lactoferrin on murine embryo development created from lipopolysaccharide-treated sperm

The effect of lactoferrin (LF) on embryo development was investigated by using lipopolysaccharide (LPS)-treated mouse sperm. For the development rate of the 2-cell stage embryo, the embryo derived from LPS- and LF-treated sperm showed similar survival rate to the control embryo. On day 12 after the embryo transfer into the recipient, the frequent abnormality was observed in the embryo derived from LPS-treated sperm, and the abnormality was tended to be inhibited in the embryo derived from LPS- and LF-treated sperm. These results imply that LF treatment on sperm contaminated with bacteria may facilitate the embryo development, which contribute to the improvement of infertility.

Genitourinary Infections Related to Circumcision and the Potential Impact on Male Infertility

Male circumcision (MC) is one of the oldest surgical procedures still completed today. Medical indications for MC include phimosis, recurrent balanitis, cosmesis, and infection prevention. In this review, we mainly focus on the role of MC in the prevention of human immunodeficiency virus, human papillomavirus, herpes simplex virus, gonorrhea, chlamydia, chancroid, and syphilis, and the subsequent impact of these genitourinary infections on male fertility. Overall, many compelling data support that MC may play an essential role in both genitourinary infection prevention and male fertility.

Microbiological Evaluation and Sperm DNA Fragmentation in Semen Samples of Patients Undergoing Fertility Investigation

Fifteen percent of male infertility is associated with urogenital infections; several pathogens are able to alter the testicular and accessory glands' microenvironment, resulting in the impairment of biofunctional sperm parameters. The purpose of this study was to assess the influence of urogenital infections on the quality of 53 human semen samples through standard analysis, microbiological evaluation, and molecular characterization of sperm DNA damage. The results showed a significant correlation between infected status and semen volume, sperm concentration, and motility. Moreover, a high risk of fragmented sperm DNA was demonstrated in the altered semen samples. Urogenital infections are often asymptomatic and thus an in-depth evaluation of the seminal sample can allow for both the diagnosis and therapy of infections while providing more indicators for male infertility management.

Is HPV the Novel Target in Male Idiopathic Infertility? A Systematic Review of the Literature

Infertility is an important health problem that affects up to 16% of couples worldwide. Male infertility is responsible for about 50% of the cases, and the various causes of male infertility may be classified in pre-testicular (for example hypothalamic diseases), testicular, and post-testicular (for example obstructive pathologies of seminal ducts) causes. Sexually transmitted infections (STI) are increasingly widely accepted by researchers and clinicians as etiological factors of male infertility. In particular, several recent reports have documented the presence of HPV in seminal fluid and observed that sperm infection can also be present in sexually active asymptomatic male and infertile patients. In this review, we aimed to perform a systematic review of the whole body of literature exploring the impact of HPV infection in natural and assisted fertility outcomes, from both an experimental and a clinical point of view. Starting from in-vitro studies in animals up to in-vivo studies in humans, we aimed to study and evaluate the weight of this infection as a possible cause of idiopathic infertility in males with any known cause of conception failure.

Sex difference in the immunogenicity of the quadrivalent Human Papilloma Virus vaccine: Systematic review and meta-analysis

BACKGROUND

Immunological differences between males and females in response to viral vaccines are well known. This the first review to examine them for the Human Papilloma Virus.

METHODS

We conducted a systematic review and meta-analysis of the immunogenicity of the Quadrivalent Human Papilloma Virus Vaccine qHPVV. We searched Medline, Embase, and CENTRAL for trials published until September 17, 2019. Inclusion criteria were 3-doses and reporting geometric mean titers (GMTs). We performed random-effects meta-analyses and meta-regression separated by age group and sex.

RESULTS

Our search yielded 1809 unique studies. 334 full texts were screened and data from 18 studies were extracted. Females had higher pooled geometric mean titers than males in all age groups. Log transformed GMTs in male children (<16) years were: against HPV6: 6·62 (95% CI 6·29-6·94; I² = 86·0%), against HPV11: 7·07 (95% CI 6·90-7·23; I² = 63.1%), against HPV16: 8·53 (95% CI 8·28-8·78; I² = 73·0%), and against HPV18 7·21 (95% CI 7·08-7·34; I² = 26·4%). In females: against HPV6 7·10 (95% CI 6·79-7·41; I² = 96·6%), HPV11: 7·32 (95% CI 7·15-7·50; I² = 90·6%), HPV16: 8·71 (95% CI 8·52-8·91; I² = 90·2%), and HPV18 7·35 (95% CI 7·11-7·58; I² = 92·7%). In the meta-regression, the sexual difference was significant for HPV6 (p = 0·022) with a similar tendency for HPV11 (p = 0·066) and HPV18 (p = 0·079). Immunogenicity was significantly higher in children (<16) than in adults (p < 0·001).

CONCLUSION

Females have higher antibody titers against HPV after receiving the qHPVV than do males. The difference is bigger in low-risk HPV strains. Adjusting the doses and schedules for each sex should be explored further.

Prevalence of and risk factors for curable sexually transmitted infections on Bubaque Island, Guinea Bissau

OBJECTIVES

Complications from sexually transmitted infections (STIs) can result in severe morbidity and mortality. To date, no STI population studies have been conducted on the Bijagos Islands, Guinea Bissau. Our objective was to estimate the prevalence of and identify risk factors for Chlamydia trachomatis (Ct), Neisseria gonorrhoea (Ng), Mycoplasma genitalium (Mg), Trichomonas vaginalis (Tv) and Treponema pallidum (Tp) on Bubaque, the most populated island.

METHODS

A cross-sectional survey was conducted on the island of Bubaque among people aged 16-49 years. Participants were asked to answer a questionnaire on STI risk factors, to provide urine samples (men and women) and vaginal swabs (women) for PCR testing for Ct, Ng, Mg and Tv, and to provide dry blood spots for Tp particle agglutination assays. Data were analysed to estimate the prevalence of STIs and logistic regression was used to identify risk factors.

RESULTS

In total, 14.9% of participants were found to have a curable STI, with the highest prevalence being observed for Tv (5.9%) followed by Ct (3.8%), Ng (3.8%), Mg (1.9%) and Tp (0.8%). Significant risk factors for having any STI included being female, younger age and concurrent partnership. Having had a previous STI that was optimally treated was a protective factor.

CONCLUSIONS

This study demonstrates that there is a considerable burden of STI on the Bijagos Islands, stressing the need for diagnostic testing to facilitate early detection and treatment of these pathogens to stop ongoing transmission. Moreover, these results indicate the need to conduct further research into the STI burden on the Bijagos Islands to help inform and develop a national STI control strategy.

Practical Clinical and Diagnostic Pathway for the Investigation of the Infertile Couple

Capsule

This expert opinion summarizes current knowledge on risk factors for infertility and identifies a practical clinical and diagnostic approach for the male and female partners of an infertile couple aimed to improve the investigation and management of fertility problems.

Background

Infertility represents an important and growing health problem affecting up to 16% of couples worldwide. In most cases, male, female, or combined factor can be identified, and different causes or risk factors have been related to this condition. However, there are no standardized guidelines on the clinical-diagnostic approach of infertile couples and the recommendations concerning infertility are sometimes lacking, incomplete, or problematic to apply.

Objective

The aim of this work is to provide an appropriate clinical and diagnostic pathway for infertile couples designed by a multidisciplinary-team of experts. The rationale is based on the history and physical examination and then oriented on the basis of initial investigations. This approach could be applied in order to reduce variation in practice and to improve the investigation and management of fertility problems.

Methods

Prominent Italian experts of the main specialties committed in the ART procedures, including gynecologists, andrologists, embryologists, biologists, geneticists, oncologists, and microbiologists, called "InfertilItaly group", used available evidence to develop this expert position.

Outcomes

Starting from the individuation of the principal risk factors that may influence the fertility of females and males and both genders, the work group identified most appropriate procedures using a gradual approach to both partners aimed to obtain a precise diagnosis and the most effective therapeutic option, reducing invasive and occasionally redundant procedures.

Conclusions

This expert position provides current knowledge on risk factors and suggests a diagnostic workflow of infertile couples. By using this step-by-step approach, health care workers involved in ART, may individuate a practical clinical management of infertile couples shared by experts.

HIV, HPV and Chlamydia trachomatis: impacts on male fertility

Sexually transmitted diseases (STDs) are pathologies that have viruses, bacteria, protozoa and fungi as infectious agents, affecting millions of people worldwide and causing physical and psychological consequences for the carrier. Some of these infections such as HIV, HPV and Chlamydia trachomatis may present an asymptomatic phase, making the diagnosis difficult, which is often only performed when the couple looks for infertility treatment after not achieving spontaneous pregnancy. Infertility affects 15% of couples, 50% of cases are male-related, and it is estimated that STDs, which interfere with the physiology of the male reproductive system and may impair semen in parameters such as motility, concentration, morphology and number, cause 15% of male infertility cases. Since STDs treatments are increasing the expectation and quality of life of infected patients, discussing issues such as sexuality and reproduction is of great importance in clarifying unknown facts. This paper aims to discuss how the infectious processes associated with HIV, HPV and Chlamydia trachomatis can interfere with semen quality causing male infertility without apparent cause.

Global epidemiology of Neisseria gonorrhoeae in infertile populations: systematic review, meta-analysis and metaregression

Objective

To provide an in-depth systematic assessment of the global epidemiology of gonorrhoea infection in infertile populations.

Methods

A systematic literature review was conducted up to 29 April 2019 on international databases and WHO regional databases, and reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All prevalence measures of gonorrhoea infection among infertile populations, based on primary data, qualified for inclusion. Infertile populations were broadly defined to encompass women/men undergoing infertility evaluation or treatment (infertility clinic attendees and partners). Pooled mean prevalence by relevant strata was estimated using random-effects meta-analysis. Associations with prevalence and sources of heterogeneity were explored using metaregression. Risk of bias was assessed using four quality domains.

Findings

A total of 147 gonorrhoea prevalence studies were identified from 56 countries. The pooled mean prevalence of current gonorrhoea infection was estimated globally at 2.2% (95% CI 1.3% to 3.2%), with the highest prevalence in Africa at 5.0% (95% CI 1.9% to 9.3%). The mean prevalence was higher for populations with tubal factor infertility (3.6%, 95% CI 0.9%–7.7%) and mixed cause and unexplained infertility (3.6%, 95% CI 0.0% to 11.6%) compared with other diagnoses, such as ovarian and non-tubal infertility (0.1%, 95% CI 0.0% to 0.8%), and for secondary (2.5%, 95% CI 0.2% to 6.5%) compared with primary (0.5%, 95% CI 0.0% to 1.7%) infertility. Metaregression identified evidence of variations in prevalence by region and by infertility diagnosis, higher prevalence in women than men and a small-study effect. There was a trend of declining prevalence by about 3% per year over the last four decades (OR=0.97, 95% CI 0.95 to 0.99).

Conclusions

Gonorrhoea prevalence in infertile populations is several folds higher than that in the general population, with even higher prevalence in women with tubal factor infertility and in individuals with secondary infertility. These findings support the potential role of gonorrhoea in infertility and suggest that some infertility is possibly preventable by controlling gonorrhoea transmission.

PROSPERO registration number

CRD42018102934.

Impact of human papillomavirus infection in semen on sperm progressive motility in infertile men: a systematic review and meta-analysis

BACKGROUND

Human papillomavirus (HPV) has been considered as one of the most common sexually transmitted viruses that may be linked to unexplained infertility in men. The possible mechanisms underlying correlation between HPV infection and infertility could be related to the altered sperm parameters. Current studies have investigated the effect of HPV seminal infection on sperm quality in infertile men, but have shown inconsistent results.

METHODS

We systematically searched PubMed, Embase, Web of Science and CNKI for studies that examined the association between HPV seminal infection and sperm progressive motility. Data were pooled using a random-effects model. Outcomes were the sperm progressive motility rate. Results are expressed as standardised mean difference (SMD) with 95% confidence interval (CI). Heterogeneity was evaluated by the I-square (I²) statistic.

RESULTS

Ten studies were identified, including 616 infertile patients with HPV seminal infection and 2029 infertile controls without HPV seminal infection. Our meta-analysis results indicated that sperm progressive motility was significantly reduced in HPV-infected semen samples compared with non-infected groups [SMD:-0.88, 95% CI:-1.17 ~ - 0.59]. There existed statistical heterogeneity (I² value: 86%) and the subgroup analysis suggested that study region might be the causes of heterogeneity.

CONCLUSIONS

HPV semen infection could significantly reduce sperm progressive motility in infertile individuals. There were some limitations in the study such as the differences in age, sample sizes and the number of HPV genotypes detected. Further evidences are needed to better elucidate the relationship between HPV seminal infection and sperm quality.

Bacteriospermia, extended spectrum beta lactamase producing Gram-negative bacteria and other factors associated with male infertility in Mwanza, Tanzania: a need of diagnostic bacteriology for management of male infertility

Background

Infections caused by Extended spectrum beta lactamase (ESBL) producing bacterial are global challenge. There is limited information on the magnitude of bacteriospermia, ESBL producing Gram-negative bacteria (GNB) causing bacteriospermia and factors associated with male infertility. This study determined magnitude of bacteriospermia, ESBL-GNB and other factors association with infertility among presumptive infertile men in Mwanza, Tanzania.

Methods

A cross-sectional hospital-based study was conducted between May 2017 and July 2018 among 137 presumptive infertile men. Semen specimens were self-collected by masturbation into clean, sterile and none-spermicidal containers and processed following laboratory standard operating procedures (SOPs). Data analysis was done using STATA 13.0.

Results

Gram-negative bacteria were predominantly isolated (86.4%), of which 31.6% were ESBL producers. In a total 44 bacteria were isolated from semen culture. The blaCTX-M gene was detected in 75% of phenotypically confirmed ESBL producers. Infertility was independently found to be associated with abnormal spermatozoa morphology (OR (95%CI): 14.48(3.17–66.05)) and abnormal spermatozoa motility (OR (95%CI): 0.05(0.01–0.24)). However, neither bacteriospermia (OR (95%CI): 0.86(0.29–2.59)) nor ESBL bacteriospermia (OR (95%CI): 0.13(0.01–1.22)) was found to be associated with infertility.

Conclusion

One third of bacteriospermia is due to ESBL-producers with history of antibiotic use being protective factor for infertility. Abnormal spermatozoa morphology and poor spermatozoa forward motility independently predicted infertility.

Global epidemiology of Neisseria gonorrhoeae in infertile populations: protocol for a systematic review

INTRODUCTION

A key target of the WHO's 'Global Health Sector Strategy on sexually transmitted infections, 2016-2021' is achieving 90% reduction in Neisseria gonorrhoeae (gonorrhoea for short) incidence globally by 2030. Though untreated, gonorrhoea has been linked to infertility, the epidemiology of this infection in infertile populations remains poorly understood and somewhat a neglected area of reproductive health. Our proposed systematic review aims to fill this gap by characterising comprehensively gonorrhoea infection in infertile populations globally.

METHODS AND ANALYSIS

All available studies of gonorrhoea infection in infertile populations, including infertility clinic attendees, will be systematically reviewed informed by Cochrane Collaboration guidelines. Findings will be reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data sources will be searched using broad index terms exploded to cover all subheadings and free text terms with no language or year restriction. Any epidemiological measure in infertile populations based on primary data will be eligible for inclusion. Measures based on different assay types will be extracted as separate studies for different analyses. Only one biospecimen type per assay type will be considered based on a predefined priority order. Samples including fewer than 10 participants or assessing infection in the upper genital tract will be excluded. Quality assessments will be conducted for all measures included in the review. Meta-analyses will be implemented using DerSimonian-Laird random effect models to estimate the mean prevalence of gonorrhoea in infertile populations globally, and stratified by WHO region, assay type, sex, infertility type, infertility diagnosis, among other factors. Detailed heterogeneity assessment will be performed, and potential sources of between-study heterogeneity will be explored using meta-regression. Review will be conducted from 26 March 2018 to 28 July 2019.

ETHICS AND DISSEMINATION

An institutional review board clearance is not required as all data are publicly available. The findings will be disseminated through a peer-reviewed publication and international scientific meetings/workshops with key stakeholders.

PROSPERO REGISTRATION NUMBER

CRD42018102934.

No detection of EBV, BKV and JCV in breast cancer tissue samples in Iran

OBJECTIVE

The most common cancer amongst women is breast cancer. Reports on the role of EBV, BKV, and JCV in the development of breast cancer are controversial. Hence, the aim of this study was to determine the frequency of EBV, BKV, and JCV in malignant breast tumors in comparison with benign ones.

RESULTS

A total of 300 breast biopsy tissues were included, of which 150 were malignant and 150 benign. After deparaffinization, tissues were subjected to DNA extraction. β-globin gene was amplified by PCR to evaluate the quality of extracted DNA. In house PCRs assay was performed to detect EBV, JCV, and BKV genome fragment. The mean age of malignant and benign groups was 45.0 ± 9.4 and 35.2 ± 12.1 years old. Out of 150 malignant samples, 146 were ductal, two lobular and two samples both invasive ductal and lobular carcinoma. In the benign group, 96, 52 and two samples were fibroadenoma, fibrocystic, and adenosis types, respectively. Genomic DNA fragment of EBV, BKV, and JCV was not found in any of the malignant and benign breast tissues.

CONCLUSION

According to our finding, there is the possibility that EBV, BKV, and JCV are not involved in breast cancer pathogenesis.

Semen Microbiome Biogeography: An Analysis Based on a Chinese Population Study

Investigating inter-subject heterogeneity (or spatial distribution) of human semen microbiome diversity is of important significance. Theoretically, the spatial distribution of biodiversity constitutes the core of microbiome biogeography. Practically, the inter-subject heterogeneity is crucial for understanding the normal (healthy) flora of semen microbiotas as well as their possible changes associated with abnormal fertility. In this article, we analyze the scaling (changes) of semen microbiome diversity across individuals with DAR (diversity-area relationship) analysis, a recent extension to classic SAR (species-area relationship) law in biogeography and ecology. Specifically, the unit of “area” is individual subject, and the microbial diversity in seminal fluid of an individual (area) is assessed via metagenomic DNA sequencing technique and measured in the Hill numbers. The DAR models were then fitted to the accrued diversity across different number of individuals (area size). We further tested the difference in DAR parameters among the healthy, subnormal, and abnormal microbiome samples in terms of their fertility status based on a cross-sectional study of a Chinese cohort. Given that no statistically significant differences in the DAR parameters were detected among the three groups, we built unified DAR models for semen microbiome by combining the healthy, subnormal, and abnormal groups. The model parameters were used to (i) estimate the microbiome diversity scaling in a population (cohort), and construct the so-termed DAR profile; (ii) predict/construct the maximal accrual diversity (MAD) profile in a population; (iii) estimate the pair-wise diversity overlap (PDO) between two individuals and construct the PDO profile; (iv) assess the ratio of individual diversity to population (RIP) accrual diversity. The last item (RIP) is a new concept we propose in this study, which is essentially a ratio of local diversity to regional or global diversity (LRD/LGD), applicable to general biodiversity investigation beyond human microbiome.

Infectious, inflammatory and 'autoimmune' male factor infertility: how do rodent models inform clinical practice?

BACKGROUND

Infection and inflammation of the reproductive tract are significant causes of male factor infertility. Ascending infections caused by sexually transmitted bacteria or urinary tract pathogens represent the most frequent aetiology of epididymo-orchitis, but viral, haematogenous dissemination is also a contributory factor. Limitations in adequate diagnosis and therapy reflect an obvious need for further understanding of human epididymal and testicular immunopathologies and their contribution to infertility. A major obstacle for advancing our knowledge is the limited access to suitable tissue samples. Similarly, the key events in the inflammatory or autoimmune pathologies affecting human male fertility are poorly amenable to close examination. Moreover, the disease processes generally have occurred long before the patient attends the clinic for fertility assessment. In this regard, data obtained from experimental animal models and respective comparative analyses have shown promise to overcome these restrictions in humans.

OBJECTIVE AND RATIONALE

This narrative review will focus on male fertility disturbances caused by infection and inflammation, and the usefulness of the most frequently applied animal models to study these conditions.

SEARCH METHODS

An extensive search in Medline database was performed without restrictions until January 2018 using the following search terms: 'infection' and/or 'inflammation' and 'testis' and/or 'epididymis', 'infection' and/or 'inflammation' and 'male genital tract', 'male infertility', 'orchitis', 'epididymitis', 'experimental autoimmune' and 'orchitis' or 'epididymitis' or 'epididymo-orchitis', antisperm antibodies', 'vasectomy'. In addition to that, reference lists of primary and review articles were reviewed for additional publications independently by each author. Selected articles were verified by each two separate authors and discrepancies discussed within the team.

OUTCOMES

There is clear evidence that models mimicking testicular and/or epididymal inflammation and infection have been instructive in a better understanding of the mechanisms of disease initiation and progression. In this regard, rodent models of acute bacterial epididymitis best reflect the clinical situation in terms of mimicking the infection pathway, pathogens selected and the damage, such as fibrotic transformation, observed. Similarly, animal models of acute testicular and epididymal inflammation using lipopolysaccharides show impairment of reproduction, endocrine function and histological tissue architecture, also seen in men. Autoimmune responses can be studied in models of experimental autoimmune orchitis (EAO) and vasectomy. In particular, the early stages of EAO development showing inflammatory responses in the form of peritubular lymphocytic infiltrates, thickening of the lamina propria of affected tubules, production of autoantibodies against testicular antigens or secretion of pro-inflammatory mediators, replicate observations in testicular sperm extraction samples of patients with 'mixed atrophy' of spermatogenesis. Vasectomy, in the form of sperm antibodies and chronic inflammation, can also be studied in animal models, providing valuable insights into the human response.

WIDER IMPLICATIONS

This is the first comprehensive review of rodent models of both infectious and autoimmune disease of testis/epididymis, and their clinical implications, i.e. their importance in understanding male infertility related to infectious and non-infectious/autoimmune disease of the reproductive organs.