Archives of Andrology

Journal of Reproductive Systems

ISSN: 0148-5016 (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/iaan19

Bacterial Infection and Semen Characteristics in

Infertile Men

G. Merino, S. Carranza-lira, S. Murrieta, L. Rodriguez, E. Cuevas & C. Moran

To cite this article: G. Merino, S. Carranza-lira, S. Murrieta, L. Rodriguez, E. Cuevas & C. Moran
(1995) Bacterial Infection and Semen Characteristics in Infertile Men, Archives of Andrology, 35:1,
43-47, DOI: 10.3109/01485019508987852

To link to this article: https://doi.org/10.3109/01485019508987852

Published online: 09 Jul 2009.

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 BACTERIAL INFECTION AND SEMEN
CHARACTERISTICS IN INFERTILE MEN

G. MERINO
S. CARRANZA-LIRA
S. -ETA
L. RODRIGUEZ
E. CUEVAS
c. MORAN
Servicio de Ginecologia EndocrindAndrologia y
Unidad de Investigacih en Medicina Reproductiva
Hospital de Gineco-Obstetricia, Tizaph, Mdxico DF, Mexico

Semen samples of 190 men attending an andrology clinic were evaluated with bacteriological culture
and categorized as negative (group I) and positive (group 11); the effect of bacteriospemia on semen
characteristics was also analyzed. Semen samples from both groups were simultaneously analyzed for
routine parameters such as volume, sperm count, motility, viability and morphology. The semen
culture was negative in 34% and positive in 66% of the samples. From 123 samples, 157 aerobes and
8 anaerobes were recovered. The most commonly isolated organism was Staphylococchs epidermidis
(in 63% of the samples), followed by Streptococchs viridans (28%), Escherichia coli (9%), Staphy-
lococcus aureus (5%), Strepfococcusfaecalis(5%), P-hemolytic Strepfococcus (4%), and Enferobacter
agglomerans (4%). Other microorganisms, including Klebsiella sp, Candida sp., and Proteus mirabilis,
were recovered in fewer than 4% of the specimens. The comparison of semen characteristics between
infected and noninfected men showed that motile spermatozoa and viability were lower when the
microorganisms were present in the semen. It would appear that the bacteria can have a direct effect
on semen quality with negative consequences in fertility.

Keywords sperm, semen, bacteria, infertility, male infertility, infection, seminal plasma

Infectious diseases may affect male reproductive function in different ways. The mechanism
of fertility is not completely understood and for some authors the possible role of infection in
infertility is controversial [14, 201. Chronic bacterial infection of semen is uncommon, but may
be a cause of male infertility [6]. The causative agents in bacterial pathologies of the genital
tract are similar to those responsible for urinary tract infection [lo, 221. The association be-
tween infection and sperm quality is supported in some studies by the finding that fewer
bacteria were found in seminal plasma of fertile men [23, 131. These microorganisms may act
either directly on the spermatozoa, indirectly on the seminal plasma, or by forming antisperm

Address correspondence to Dra. G. Merino, Apartado Postal 21-567, C.P. 04021 Mtxico DF, Mexico.

ARCHIVES OF ANDROLOGY 3 5 4 3 4 7 (1995) 43

Copyright 0 1995 Taylor & Francis
0148-5016B5$10.00 + .OO
44 G. Merino et al.

antibodies [ 11. Among the numerous factors determining infertility, infection is the most com-
mon in the developing countries.
This investigation was conducted to evaluate the prevalence of bacterial flora of semen and
its association with sperm quality and semen characteristics of infertile men visiting the Instituto
Mexican0 del Seguro Social (IMSS) andrology clinic in Mexico City.

MATERIALS AND METHODS

Semen specimens were evaluated from 190 men between 20 and 49 years of age (average of 30 f
6.8) who were free of genitourinary symptoms. All men denied any medication in the past 3 months.
Candidates were excluded if they had had a varicocele in the previous 2 years, an undescended testis, or
other genital or groin injury. At the time of enrollment, the men were examined for urethral discharge
and were excluded if it was present. All men were in monogamous relationships. The men were in-
structed to abstain from ejaculation for 3 days before they visited the clinic. Hands and penis were
washed with bactericidal soap, then semen samples were obtained by masturbation and placed into a
sterile specimen container. The men were not allowed to use any lubricants during collection of the
specimen.
Within 5 min of collection, 0.5 mL of the semen was taken for microbiological examination. The
remainder was allowed to liquefy for 20 min and was examined for the volume, number of spermatozoa
(using a hemocytometer), percentage of motile spermatozoa, viability, sperm morphology, and leuko-
cytes (examined by light microscopy). A detailed analysis of sperm morphology was performed as
described by Eliasson in 1971 [S]. For sperm analysis, standard criteria of the World Health Organization
were followed [25]. A semen bacterial culture was conducted as previously described [9].
Statistical evaluation of the data was carried out using the Student t test with the Minitab computer-
ized program.

RESULTS

Semen Characteristics
The men were 20 to 49 years old with a range of 30.1 f 6.8 (mean f SD). The duration of
sterility was 1-12 years (4.0 f 2.8). Of the 190 patients included in this study, 126 had normal
sperm counts (66%), 7 were azoospermic (3.7%), and 19 were oligozoospermic (10%). Pri-
mary infertility was noted in 112 (59%) and secondary infertility in 78 (41%). After excluding
the cases of azoospermia, the results were based on 183 subjects. The samples were divided in
two groups based on the result of bacteriological analysis. The samples were divided in two
groups based on the result of bacteriological analysis. The samples that did not show positive
culture were designated as group I (n = 64) (34%) and bacteriological positive samples were
labeled group I1 (n = 119) (66Yo).
The semen characteristics are summarized in Table 1. There were statistically significant
differences in semen volume, motility, and viability among the groups. The motility and viabil-
ity were higher in group 1.
Semen Bacteriology
All microorganisms (aerobes and anaerobes) present in the semen were identified and are
summarized in Table 2. Of these 119 samples, 157 were positive for aerobic bacteria and 8
were positive for anaerobic bacteria. Staphylococcus epidermidis was found in 63% of the
 Effect of Bacteria on Semen Quality 45

TABLE 1 Relationship Between Semen Cultures and Semen Characteristics

Parameters Negative Culture Positive Culture P

Number of patients 64 119

Semen volume (mL) 2.8 1.5 *
2.4 1.0 ,063
Sperm count *
167 128 *
165 157 NS
Motility (%) *
47 12 37* I3 ,000 1
Viability (%) 74* 13 *
64 14 .0001
Normal morphology (%) 4 2 * 13 3 9 * 11 NS

Note. N S , not significant.

samples, Streptococcus viridans in 28%, Escherichia coli in 8%, Staphylococcus aureus in 5%,
P-hemolytic Streptococcus in 4%, and Enterobacter agglomerans in 4%. Other microorgan-
isms included Klebsiella sp; Candida sp; Proteus mirabilis sp; and lactic bacilli sp. Diptherois
were recovered in fewer than 4% of the specimens.

DISCUSSION
This study concentrated mainly on the asymptomatic subclinical infection and its relation to
infertility. The diagnosis of male accessory genital organs inflammation is difficult and the
influence on fertility is debatable. There is a great variability in different studies on the inci-
dence of bacterial isolation in the semen of fertile and infertile men. Positive cultures of fertile

TABLE 2 Aerobic and Anaerobic Bacterial Isolation

from 119 Infertile Men

Bacteria n %

Aerobic
Staphylococcus epidermidis 75 63
Streptococcus viridans 33 28
Escherichia coli 9 8
Staphylococcus aureus 6 5
Streptococcus faecalis 6 5
P-hemolytic Streptococcus 6 5
Enterobacter agglomerans 5 4
Klebsiella sp. 5 4
Candida sp. 3 2
Proteus mirabilis 3 2
Lactic bacilli 1 1
Gram + coccus 1 1
Diphteroid bacilli 3 2
Gram-negative bacilli 1 1
Anaerobic
Gardnerella vaginalis 5 4
Neisseria sp. 3 2

Note. Semen culture results: The total is greater than 100% be-
cause 1, 2, or 3 microorganisms were isolated from some samples.
46 G. Merino et al.

men varied between 13 and 100% and in infertile men varied between 11 and 100% [2, 3, 8,
1 1-13, 15, 19, 21, 23, 241. We attempted to delineate the effects of bacterial infection on the
basis of seminal characteristics. Staphyococcus epidermidis has been reported to have a preva-
lence in semen of 24-100% [15,23], and in this study was of63%. Streptococcus viridans was
recovered in 28% of the semen specimens compared with 1 5 7 4 % in other studies [13, 231.
Anaerobic gram-positive cocci were recovered from 6% of the specimens, compared with 16-
19% in those other studies [15, 231. We restrict our investigation to aerobic and anaerobic
bacteria due to lack of finds to evaluate other microorganisms, such as Ureaplasma urealyticum
and Chlamydia trachomatis.
The results of the present study indicate that bacterial infection cause alteration in seminal
characteristics in volume, motility, and viability. The decrease in sperm motility may be due to
immobilization [17, 181 or death of spermatozoa due to the action of bacterial toxins [4].
Previous studies have also shown that a decrease in sperm morphology may be due to bacterial
disintegration [7], but there was no difference in this characteristic in the present study. There
was a tendency for semen values to be more increased in group I than in group 11. Some
authors could find no difference between semen characteristics from groups of infected and
noninfected infertile men [ 11, 131. Hillier et al. [8] found no difference in semen parameters
according to the number of different types of microorganisms, Conversely, in a comparison of
100 infertile and fertile men having a positive semen culture, Jacques et al. [9] found a lower
percentage of motile spermatozoa (27 vs. 35%, p < .OOl). One explanation for the wide vari-
ability of results might be differences in patients recruitment, as well as different methods of
semen collection and asepsis.

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