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

Kareim Khalafalla; Walid El Ansari; Pallav Sengupta; Ahmad Majzoub; Haitham Elbardisi; Onder Canguven; Kareem El-Ansari; Mohamed Arafa

doi:10.1080/2090598X.2023.2218566

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

Arab J Urol. 2023 Jul 5;21(4):216-232. doi: 10.1080/2090598X.2023.2218566. eCollection 2023.

Authors

Kareim Khalafalla^{1

2

3}, Walid El Ansari^{4

5

6}, Pallav Sengupta^{7

8}, Ahmad Majzoub^{1

9}, Haitham Elbardisi^{1

5

9}, Onder Canguven^{1

9}, Kareem El-Ansari⁸, Mohamed Arafa^{1

9

10}

Affiliations

¹ Department of Urology, Hamad General Hospital, Doha, Qatar.
² Department of Urology, University of Texas Health Science Center, Houston, Texas, USA.
³ Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
⁴ Department of Surgery, Hamad Medical Corporation, Doha, Qatar.
⁵ College of Medicine, Qatar University, Doha, Qatar.
⁶ Department of Population Health, Weill Cornell Medicine-Qatar, Doha, Qatar.
⁷ Physiology Unit, Department of Biomedical Sciences, School of Medicine, Gulf Medical University, Ajman, UAE.
⁸ Faculty of Medicine, Ain Shams University, Cairo, Egypt.
⁹ Department of Urology, Weill Cornell Medicine-Qatar, Doha, Qatar.
¹⁰ Department of Andrology, Cairo University, Cairo, Egypt.

Abstract

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.

Keywords: Male infertility; semen quality; sexually transmitted infections.

Publication types

Review