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Sexually Transmitted Infection and Male Infertility
Published in Botros Rizk, Ashok Agarwal, Edmund S. Sabanegh, Male Infertility in Reproductive Medicine, 2019
Kareim Khalafalla, Haitham Elbardisi, Mohamed Arafa
The exact mechanism of infertility is also controversial. The initial response to C. trachomatis infection is the generation of interleukin-1 (IL-1), which in turn results in the stimulation of polymorphonuclear white blood cells (WBCs). Leukocytospermia will lead to increased production of ROS with an increase in oxidative stress in semen followed by deterioration of all semen parameters, increased sperm DNA damage, and impairment of acrosome reaction. The sperm itself will also add to the increase of ROS associated with C. trachomatis infection as the organism has abundant lipopolysaccharides on its membrane, which attaches to CD14 receptors on the sperm, resulting in production of large amounts of ROS. Also, C. trachomatis is believed to cause immunological infertility with increased production of antisperm antibodies. Infection will lead to increased humoral response with local invasion of macrophages, lymphocytes, plasma cells, and eosinophils, resulting in production of local secretory immunoglobulin A (IgA) and circulating immunoglobulin M (IgM) and immunoglobulin G (IgG). The increase in chlamydia antibodies has been associated with deterioration of semen parameters [26,27].
Chlamydia Pneumonitis
Published in Lourdes R. Laraya-Cuasay, Walter T. Hughes, Interstitial Lung Diseases in Children, 2019
Harrison et al.47 suggest the probability of long-term sequelae following infantile Chlamydia pneumonia. In this study, sera available from children admitted to the hospital with lower respiratory tract illnesses were retrospectively analyzed for presence of Chlamydia antibodies. These patients were subsequently followed for the development of chronic respiratory disease with clinical questionnaires and pulmonary function tests. Of the ten infants identified to have chlamydial infections based on the serological analysis, four were followed for an average of 67 months. Four others were followed for an average of 11.8 months. The other two patients were excluded because of insufficient data. Eight patients without the serological diagnosis of Chlamydia were followed for an average of 57 months. Results revealed that children in the Chlamydia group were much more likely to have persistent cough, wheezing, and abnormal functional residual capacity (FRC) than those without a serologic diagnosis of Chlamydia infection. However, this study involves a small number of patients with significant loss to follow up.
The Epidemiology of Infertility
Published in Michele Kiely, Reproductive and Perinatal Epidemiology, 2019
Case-control studies in North American52-55 and elsewhere56,57 consistently show that women with tubal infertility are more likely to have Chlamydia antibodies, and to have higher antibody titers than fertile women or women with other types of infertility. Antibody formation in response to gonorrhea is less consistent, and thus there is less seroepidemiologic evidence regarding the relation between gonococcal PID and infertility.58 The genital Mycoplasmas are sexually transmitted and often found to be present with other STDs, but their role as independent or contributing causes of infertility in humans has not been defined.59-61 The risk of infertility in males following these infections has not been quantitated in western populations, but is thought to be much lower than in females.
Navigating to the most promising directions amid complex fields of vaccine development: a chlamydial case study
Published in Expert Review of Vaccines, 2019
David Lizárraga, Scott Carver, Peter Timms
The production of anti-chlamydial antibodies in response to chlamydial infection has been discussed and investigated since the early testing of modern chlamydial immunizations in the 1960s [55,56]. An increase in anti-Chlamydia antibodies has been negatively correlated with chlamydial load through a number of mechanisms proposed (e.g. opsonization, antibody-dependent cellular cytotoxicity, or complement activation) [12,57]. Indeed, mechanisms of chlamydial reduction as measured by serum neutralization assays are dependent on antibody function (i.e. recognition or neutralization). In our meta-analysis, we found both IgA and IgG2a antibody increase correlated with chlamydial load decrease for mice immunized against either C. muridarum or C. trachomatis. Additionally, an increase in IgG1 was correlated with C. muridarum load reduction (18 studies), but not C. trachomatis load reduction (five studies). More studies measuring IgG1, IgG2b, or IVN may make these relationships clearer. Lastly, our analysis shows that systemic IgG is the most common antibody measured for Chlamydia immunization studies. Previous work has shown that mucosal IgA antibodies, and not systemic IgG, are likely to be a more relevant marker of chlamydial protection [58]. Future studies should consider measurements of mucosal immune parameters when determining the effects of chlamydial immunizations on host protection.
Time to re-evaluate the guidance on sexual infections in fertility services
Published in Human Fertility, 2021
Daisy Ogbonmwan, Jane Hussey, Madhavi Gudipati
Development of local pathways between sexual health services and fertility clinics to ensure support for the screening and management of STIs including partner notification. BASHH guidance for STI treatment management (www.bashh.org/guidelines) should be followed.Inclusion of STI screening during the early stages of fertility assessment. This should include serology for HIV and Syphilis, first void urine in men and self-taken vaginal swab in women (not cervical swab) for combined Chlamydia and Gonorrhoea NAAT test. Other STIs to consider where local testing exists include MGen NAAT by vaginal swab in women for women with suspected PID and men with orchitis.Inclusion of STI screening in women due to undergo invasive procedures involving the reproductive system (e.g. egg collection), in order to allow any infection to be managed appropriately prior to the procedure. Current sexual partners should also be screened. Screening must include as a minimum vaginal swab for Chlamydia and Gonorrhoea NAAT. Empirical antibiotics should not be offered in place of screening.Testing for Chlamydia antibodies (serology) may be an indicator of current or past infection and may highlight women whose Fallopian tubes may be damaged as a result. However, antibodies (serology) in some cases may not detect current infection. They should therefore not be used in place of a vaginal NAAT test and consideration should be given to all women with a positive STI result being considered for further investigations of tubal patency.Some studies suggest that STIs may damage sperm quality. Further research is needed to determine reversibility of male fertility following successful STI treatment as previous studies have shown mixed results. It may be necessary to repeat semen analysis, in men with male infertility after any positive STI has been treated prior to continuing with further fertility management.Inclusion of STI screening and treatment prior to storage of sperm, eggs and embryo.