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Male Genital Tract Chlamydial Infection: Implications for Pathology and Infertility

Abstract
Chlamydia trachomatis infections are prevalent worldwide, but current research, screening and treatment is focussed on females, with the burden of disease and infertility sequelae considered predominantly a female problem. However, the prevalence of chlamydial infection is similar in males and females. Furthermore, a role for this pathogen in the development of male urethritis, epididymitis and orchitis is widely accepted. While the role of Chlamydia in the development of prostatitis is controversial, we suggest that Chlamydia is an aetiological agent, with incidences of up to 39.5% reported in prostatitis patients. Infection of the testis and prostate is implicated in a deterioration of sperm, possibly affecting fertility. Chlamydia infections may also affect male fertility by directly damaging the sperm, as sperm parameters, proportion of DNA fragmentation, and acrosome reaction capacity are impaired with chlamydial infection. Furthermore, the proportion of male partners of infertile couples with evidence of a Chlamydia infection is greater than documented in the general population. An effect of male chlamydial infection on the fertility of the female partner has also been reported. Thus the need for a vaccine to protect both males and females is proposed. The difficulty arises because the male reproductive tract is an immune privileged site which can be disrupted, potentially affecting spermatogenesis, if inappropriate inflammatory responses are provoked. Examination of responses to infection in humans and in experimental animal models suggest that an IgA-inducing vaccine will be able to effectively target the male reproductive tract, while avoiding harmful inflammatory responses that may impair fertility.

Key words: Male Reproductive Tract • Male sexual function • Prostate • Sperm • Chlamydia