Low Sperm Counts in Genitourinary Medicine Clinic Attendees
Objectives To conduct a case–control study of abnormalities in the semen of genitourinary (GU) medicine clinic attendees compared with general practice (GP) controls and in patients with asymptomatic and symptomatic non-specific urethritis (NSU) before and after the urethritis resolves.
Methods Rates of semen abnormalities were compared between the different groups (19 with symptomatic and 27 with asymptomatic NSU, seven with symptomatic non-NSU and 64 clinic controls) and between clinic attendees and 417 patients attending GP for the first investigation of possible infertility. Those with symptomatic or asymptomatic NSU gave repeat semen samples on resolution of the NSU.
Results The study included 117 clinic volunteers. They were shown to have statistically significantly worse total sperm counts (p=0.002), volume of semen (p<0.001) and percentage of abnormal forms (p<0.04) compared with 417 GP controls. Compared with the rest of the clinic volunteers, asymptomatic NSU patients had statistically significantly lower total sperm counts (p<0.02). Asymptomatic NSU patients had statistically significantly lower total sperm counts compared with symptomatic NSU patients (p<0.02). Compared with GP controls, clinic controls had statistically significantly inferior total sperm counts (p=0.009) and semen volume (p<0.001).
Conclusions GU clinic attendees are more likely to have abnormalities of semen than patients attending GP for the first check for possible infertility. A high rate of abnormal semen findings are found in patients with and without NSU but the highest rate occurred in those with asymptomatic NSU. Is asymptomatic NSU therefore pathogenic and does it require treatment like symptomatic NSU?
In developed countries, 22% of infertility is caused by a male factor alone and in a further 21% both male and female factors are involved. Subfertility affects one in 20 men. Known causes of male subfertility are genital tract infection (epididymitis and orchitis), testicular disease and abnormalities, systemic disease and external factors, for example, drugs. Male subfertility is rarely caused by endocrine deficiency. The evidence linking environmental factors and impaired human fertility is weak.
Epididymitis, a recognised cause of male infertility, is a common complication of urethritis. In genitourinary (GU) medicine clinics in the UK, cases of non-chlamydial/non-gonococcal (non-specific) epididymitis are seven times as common as those associated with Chlamydia trachomatis. It is well recognised that C trachomatis infection in women can cause infertility following a symptomatic pelvic infection or asymptomatically without a clinically apparent salpingitis. Although it is known that symptomatic epididymitis can cause male infertility, there is no clear in vivo evidence that asymptomatic non-chlamydial urogenital infection can have an adverse effect on male fertility.
The findings of an epidemiological study suggested an association between infection with C trachomatis (CT) in men and unexplained infertility and implied that infection was frequently asymptomatic. CT has been found to be asymptomatic in around 50% or more cases in community and clinic settings in the UK and in a rural setting in Tanzania.
In vitro work suggests that male genital tract infections may adversely affect sperm quality and fertilising potential by a variety of mechanisms, for example, infection-related impairment of accessory gland function, partial or full obstruction of sperm transport, infection-related disruption of the blood-testis barrier inducing the generation of anti-sperm antibodies, and so on.
The diagnosis of non-specific urethritis (NSU) (non-chlamydial and non-gonococcal) is made on microscopy. The latest guideline from the British Association for Sexual Health and HIV has changed former guidance so that screening for asymptomatic NSU and checking for unresolved asymptomatic NSU after treatment of symptomatic NSU are no longer advocated. However, other clinicians have advocated caution in adopting such policies before further research has been done. This study examines fertility in men with NSU, that is, negative for both Neisseria gonorrhoeae (NG) and CT, and other clinic attendees. Primary aims were to investigate whether there is a higher incidence of abnormalities in the semen of men with urethritis compared with controls and second to investigate whether any abnormalities found in the semen of men with urethritis are corrected when the urethritis resolves. A secondary aim was to investigate whether asymptomatic urethritis has similar effects (if any) on semen to symptomatic urethritis. The hypothesis was that just as infertility may be caused by either symptomatic or asymptomatic infection in women, so the same may occur in men.
Abstract and Introduction
Abstract
Objectives To conduct a case–control study of abnormalities in the semen of genitourinary (GU) medicine clinic attendees compared with general practice (GP) controls and in patients with asymptomatic and symptomatic non-specific urethritis (NSU) before and after the urethritis resolves.
Methods Rates of semen abnormalities were compared between the different groups (19 with symptomatic and 27 with asymptomatic NSU, seven with symptomatic non-NSU and 64 clinic controls) and between clinic attendees and 417 patients attending GP for the first investigation of possible infertility. Those with symptomatic or asymptomatic NSU gave repeat semen samples on resolution of the NSU.
Results The study included 117 clinic volunteers. They were shown to have statistically significantly worse total sperm counts (p=0.002), volume of semen (p<0.001) and percentage of abnormal forms (p<0.04) compared with 417 GP controls. Compared with the rest of the clinic volunteers, asymptomatic NSU patients had statistically significantly lower total sperm counts (p<0.02). Asymptomatic NSU patients had statistically significantly lower total sperm counts compared with symptomatic NSU patients (p<0.02). Compared with GP controls, clinic controls had statistically significantly inferior total sperm counts (p=0.009) and semen volume (p<0.001).
Conclusions GU clinic attendees are more likely to have abnormalities of semen than patients attending GP for the first check for possible infertility. A high rate of abnormal semen findings are found in patients with and without NSU but the highest rate occurred in those with asymptomatic NSU. Is asymptomatic NSU therefore pathogenic and does it require treatment like symptomatic NSU?
Introduction
In developed countries, 22% of infertility is caused by a male factor alone and in a further 21% both male and female factors are involved. Subfertility affects one in 20 men. Known causes of male subfertility are genital tract infection (epididymitis and orchitis), testicular disease and abnormalities, systemic disease and external factors, for example, drugs. Male subfertility is rarely caused by endocrine deficiency. The evidence linking environmental factors and impaired human fertility is weak.
Epididymitis, a recognised cause of male infertility, is a common complication of urethritis. In genitourinary (GU) medicine clinics in the UK, cases of non-chlamydial/non-gonococcal (non-specific) epididymitis are seven times as common as those associated with Chlamydia trachomatis. It is well recognised that C trachomatis infection in women can cause infertility following a symptomatic pelvic infection or asymptomatically without a clinically apparent salpingitis. Although it is known that symptomatic epididymitis can cause male infertility, there is no clear in vivo evidence that asymptomatic non-chlamydial urogenital infection can have an adverse effect on male fertility.
The findings of an epidemiological study suggested an association between infection with C trachomatis (CT) in men and unexplained infertility and implied that infection was frequently asymptomatic. CT has been found to be asymptomatic in around 50% or more cases in community and clinic settings in the UK and in a rural setting in Tanzania.
In vitro work suggests that male genital tract infections may adversely affect sperm quality and fertilising potential by a variety of mechanisms, for example, infection-related impairment of accessory gland function, partial or full obstruction of sperm transport, infection-related disruption of the blood-testis barrier inducing the generation of anti-sperm antibodies, and so on.
The diagnosis of non-specific urethritis (NSU) (non-chlamydial and non-gonococcal) is made on microscopy. The latest guideline from the British Association for Sexual Health and HIV has changed former guidance so that screening for asymptomatic NSU and checking for unresolved asymptomatic NSU after treatment of symptomatic NSU are no longer advocated. However, other clinicians have advocated caution in adopting such policies before further research has been done. This study examines fertility in men with NSU, that is, negative for both Neisseria gonorrhoeae (NG) and CT, and other clinic attendees. Primary aims were to investigate whether there is a higher incidence of abnormalities in the semen of men with urethritis compared with controls and second to investigate whether any abnormalities found in the semen of men with urethritis are corrected when the urethritis resolves. A secondary aim was to investigate whether asymptomatic urethritis has similar effects (if any) on semen to symptomatic urethritis. The hypothesis was that just as infertility may be caused by either symptomatic or asymptomatic infection in women, so the same may occur in men.
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