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II.2.4 Urethritis, Sexually Transmitted Diseases (STD), Acquired Immunodeficiency Syndrome (AIDS) 327

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II.2.4 Urethritis, Sexually Transmitted Diseases (STD), Acquired Immunodeficiency Syndrome (AIDS) 327 II.2.4 Urethritis, Sexually Transmitted Diseases (STD), Acquired Immunodeficiency Syndrome (AIDS) 327 tween chronic prostatitis syndrome and pelvic venous dis- Wilson M, Seymour R, Henderson B (1998) Bacterial pertur- ease: a survey of 2,554 urological outpatients. Eur Urol bation of cytokine networks. Infect Immun 66:2401–2409 37:400–403 Witkin SS (1988) Mechanisms of active suppression of the im- Purvis K, Christiansen E (1993) Infection in the male repro- mune response to spermatozoa. Am J Reprod Immunol Mic- ductive tract. Impact, diagnosis and treatment in relation to robiol 17:61–64 male infertility. Int J Androl 16:1–13 Witkin SS, Kligman I, Bongiovanni AM (1995) Relationship Rajasekaran M, Hellstrom WJ, Naz RK, Sikka SC (1995) Oxida- between asymptomatic male genital tract exposure to Chla- tive stress and interleukins in seminal plasma during leuko- mydia trachomatis and an autoimmune response to sperma- cytospermia. Fertil Steril 64:166–171 tozoa. Hum Reprod 10:2952–2955 Rowe PJ, Comhaire FH, Hargreave TB, Mahmoud AM (2000) Wolff H (1995) The biological significance of white blood cells World Health Organization manual for the standardized in- in semen. Fertil Steril 63:1143–1157 vestigation, diagnosis and management of the infertile Wolff H (1998) Methods for the determination of male genital male, 1st edn. Cambridge University Press, Cambridge tract inflammation. Andrologia 30:35–39 Shimoya K, Matsuzaki N, Ida N, Okada T, Taniguchi T, Sawai K, WolffH,PolitchJA,MartinezA,HaimoviciF,HillJA,Anderson Itoh S, Ohashi K, Saji F, Tanizawa O (1995) Detection of DJ (1990) Leucocytospermia is associated with poor semen monocyte chemotactic and activating factor (MCAF) and quality. Fertil Steril 53:528–536 interleukin (IL)-6 in human seminal plasma and effect of Yamauchi-TakiharaK,IharaY,OgataA,YoshizakiK,AzumaJ, leukospermia on these cytokine levels. Am J Reprod Immu- Kishimoto T (1995) Hypoxic stress induces cardiac myocy- nol 34:311–316 te-derived interleukin-6. Circulation 91:1520–1524 Shoskes DA, Albakri Q, Thomas K, Cook D (2002) Cytokine Yanushpolsky EH, Politch JA, Hill JA, Anderson DJ (1995) An- polymorphisms in men with chronic prostatitis/chronic tibiotic therapy and leucocytospermia: a prospective, ran- pelvic pain syndrome: association with diagnosis and treat- domised, controlled study. Fertil Steril 63:142–147 ment response. J Urol 168:331–335 Yoshimura T, Matsushima K, Oppenheim JJ, Leonard JJ (1987) Tomlinson MJ, Barratt CLR, Cooke ID (1993) Prospective Neutrophil chemotactic factor produced by lipopolysaccha- study of leukocytes and leukocyte subpopulations in semen ride (LPS)- stimulated human blood mononuclear leuko- suggests they are not a cause of male infertility. Fertil Steril cytes: partial characterization and separation from interleu- 60:1069–1075 kin 1 (IL 1). J Immunol 139:788–793 WeidnerW,KrauseW,LudwigM(1999)Relevanceofmaleac- Zalata AA, Christophe A, Depuydt CE, Schoonjans F, Comhaire cessory gland infection for subsequent fertility with special FH (1998) White blood cells cause oxidative damage to the focus on prostatitis. Hum Reprod 5:421–432 fatty acid composition of phospholipids of human sperma- Westendorp RG, Langermans JA, Huizinga TW, Verweij CL, tozoa. Int J Androl 21:154–162 Sturk A (1997) Genetic influence on cytokine production in Zalata AA, Ahmed AH, Allamaneni SS, Comhaire FH, Agarwal meningococcal disease. Lancet 28; 349(9069):1912–1913 A (2004) Relationship between acrosin activity of human WHO (1987) Towards more objectivity in diagnosis and man- spermatozoa and oxidative stress. Asian J Androl 6:313–318 agement of male infertility. Int J Androl [Suppl 7] 19–33 II.2.4 Urethritis, Sexually Transmitted Diseases (STD), Acquired Immunodeficiency Syndrome (AIDS) F. R. Ochsend orf Summary According to the present data, urethritis poses no paired with progression of the acquired immuno- problem for male fertility. In chronic infections, for deficiency. Reproduction in HIV-serodiscordant example gonorrhoea, urethral strictures and epidi- couples is possible by special sperm washing pro- dymo-orchitis are possible. Chlamydia trachomatis cedures and testing of the samples prior to assisted and Neisseria gonorrhoeae can lead to pelvic in- reproductive techniques. flammatory disease of the female partner and tubal obstruction. Depending on the local prevalence some sexually transmitted disease (STD) agents can II.2.4.1 impair male fertility if not adequately treated. Any Introduction II.2 STD increases the chance of transmission of human immunodeficiency virus (HIV). HIV infection is as- A common feature shared by STD is that the causative sociated with infectious semen and the risk of trans- microorganisms are labile in inanimate environments. mission of the virus. Men who are seropositive only Therefore, they are only transmitted via intimate con- and do not have full-blown AIDS often present with tact. They are summarized in Table II.2.4 and normal semen parameters. Their endocrine and Chap. I.6.1. Due to their shared mode of transmission, exocrine testicular functions are, however, im- several of these agents may be transferred together, so the diagnosis of one STD prompts the search for others. 328 II.2 Mechanisms of Dysfunction and Pathology Table II.2.4. The most common microorganisms causing urethritis, their diagnoses and treatment. The percentages are taken from the literature; in case of strong variance, the maximal and minimal numbers are given in parentheses (from Gall et al. 1999; Elsner et al. 1987; Heise 2001; Kohl 2001) Microorganism and Frequency (%) Detection method Therapy incubation time Neisseria gonorrhoea [0] 0.4 – 9– [18] Culture (Thayer-Martin Once: spectinomycin 2 g or ceftriaxone 1–6 (–14) days selective medium; fast trans- 0.25 g i.m. alternatively (p.o.): cefixim port!); DNA hybridization 400 mg or ciprofloxacin 500 mg or ofloxacin (first-void urine) 400 mg or azithromycin 1 g C. trachomatis [6] 15–26 Ag-detection (direct immu- Once: azithromycin 1 × 1000 mg or 7 days: 7–21 days nofluorescence, EIA), DNA doxycycline2×100mg;alternative:(7days amplification (PCR; LCR) p.o.): tetracyclines 4 × 500 mg or erythro- mycin 4 × 500 mg or ofloxacin 2 × 300 mg Mycoplasma 10–21 Culture (special medium) As Chlamydia Ureaplasma urealyticum 15–17 Mycoplasma hominis 4–6 Mycoplasma genitalium 18–45 Special culture (no routine 7 days doxycycline 2 × 100 mg/day; alterna- (Deguchi and Maeda 2002) method available) tive: macrolides, new chinolone Pathogenic bacteria (Entero- [4] – 20–31 Culture According to antibiogram coccus, beta-haemolysing streptococci, E. coli, Staphylo- coccus aureus) Trichomonas vaginalis 0.4–1 Urine sediment of first-void Once metronidazole 2 g p.o. or tinidazole 4daysto3weeks urine 2gp.o. Herpes simplex Single cases Only if no therapeutic effect: Aciclovir5×200mgp.o.5–7days culture, antigen detection or PCR Candida Single cases 3 Only if no therapeutic effect: Topical imidazole derivative; alternative: culture p.o.: fluconazole 1 × 150 mg p.o. or keto- conazole 2 × 200 mg 5 days No agent demonstrable –26 Possible causes: False-negative test Repetition of microbiologic Functional irritation tests, history Traumatic urethritis Tumours of the urethra Urologic diagnostics HPV infection (urethroscopy) General disease History STDs can lead to pelvic inflammatory disease (Ankum is likely that the prevalence of STDs, the availability of et al. 1996), ectopic pregnancy, infertility, chronic pel- health services, and the time and mode of STD treat- vic pain, genital lesions, genital neoplasms, adverse ment in a given population are all factors influencing pregnancy outcomes, immune system dysfunction, liv- the role of these infections in male infertility (Cates et er disease, gonococcal sepsis and even death; so, they al. 1985; De Schryver and Meheus 1990; Bambra 1999; have a considerable impact on the health of men and Jansen et al. 2003; Orroth et al. 2003; Bayasgalan et al. women. Even if the disease does not cause definite im- 2004). There are several reviews addressing these ques- pairment of sperm parameters, for example Chlamydia tions in more detail (Keck et al. 1998; Comhaire et al. trachomatis infections in men, it may be transferred to 1999; Paavonen and Eggert-Kruse 1999; Sulak 2003). the female partner and so has considerable impact in II.2 women, such as pelvic inflammatory disease resulting in tubal occlusion (Sulak 2003). II.2.4.2 There are studies reporting a positive history con- Urethritis cerning STDs in 45% of infertile patients (Schulenburg II.2.4.2.1 et al. 1993), while others did not find associations be- Pathogens tween prior urethral discharge or dysuria and subse- quent semen quality (Oldereid et al. 1992). A higher Urethritis can be caused by several pathogens (Ta- percentage of STD agents was reported in infertile men ble II.2.4; Elsner et al. 1987; Gall et al. 1999; Heise 2001; and women than in controls (Rodriguez et al. 2001). It Kohl 2001; Deguchi and Maeda 2002). The most rele- II.2.4 Urethritis, Sexually Transmitted Diseases (STD), Acquired Immunodeficiency Syndrome (AIDS) 329 vant are gonorrhoea, Chlamydia trachomatis, Urea- Especially in Africa infertility due to tubal obstruc- plasma urealyticum, Mycoplasma genitalium, Tricho- tionappearstobearelevantissue(Meheusetal.1986). monas vaginalis (Table II.2.4). Urethritis caused by me- In men urethral strictures may occur (Osoba 1981; Fie- chanical trauma is unrelated to infertility. Ascension of vet et al. 1987). Most strictures are seen in the posterior gonococci is estimated
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