Bacteria are microscopic, single celled organisms that are found everywhere.  Normally, there are many beneficial bacteria present in your body but there are also others that could harm you by causing illness either by growing and multiplying quickly or by producing toxins or poisons.  Harmful bacteria could get into your body through your mouth, nose, eyes, through cuts in your skin, through contact with contaminated bodily fluids like semen, saliva, blood, or vaginal secretions or also through faeces.  Harmful bacteria could also be introduced from the environment through contaminated droplets or dust, from an infected person or animal, from contaminated food or water, or even from an insect bite. 

The link between bacterial infections and male fertility

Infertility is defined as not being able to conceive after having regular unprotected sex for a year or more.  When your body is invaded by a harmful bacteria, your body tries to fight it off by creating an immune response like producing antibodies and other things to trap and kill this foreign invasion.  The body’s defense mechanism against infection and signs that it’s fighting an infection could be fever, mucus production, swelling or inflammation, headache, fatigue, and pain amongst other things.  Some bacterial infections could impact fertility by causing inflammation and/or scarring in the reproductive system whereas others could affect sperm production, sperm transport or damage sperm by damaging its outer structure or chromosomal integrity.  Bacteria could infect various parts of the male reproductive system which include the urethra which transports urine from the bladder to the penis and also transports semen, seminal vesicles which produce semen, prostate which produce fluid that nourishes and protect the sperm, epididymis that stores, matures and transports sperm from the testes, vas deferens which transport mature sperm to the urethra for ejaculation, and testes which produces sperm and the hormone testosterone.

Epididymis is a coiled tube at the back of the testicle that stores and carries sperm and infection of this, which is called epididymitis, could cause swollen scrotum, pain during urination, pain in testicle, abnormal discharge from penis and sometimes blood in the semen.  If it isn’t treated for a long while, it could cause issues with sperm production.  Orchitis is infection in one or both of the testicles and it could cause pain and swelling in the testicles, fever, nausea and/or blood in semen.  The prostate is a gland below the bladder that adds fluid (which provides nutrition for the sperm) to the semen, and helps push the semen through the urethra through which the semen and urine come out.  Sometimes bacteria from urine could leak into the prostate or having sexual intercourse with a contaminated partner could lead to prostate infection (prostatitis) and this could affect your fertility.  Its symptoms include blood in semen, painful urination and ejaculation, pain during sex, abdominal pain and having difficulty urinating.  Sometimes, the balance between the beneficial and harmful bacteria in the reproductive system could be thrown off by the harmful bacteria becoming more predominant leading to issues with fertility.  Sometimes, infertility could be asymptomatic or have no signs or symptoms until you begin trying to have a baby and are finding it difficult to conceive.  Other times, you may have symptoms like the ones mentioned above.

To test for any infection, they might do a physical exam, do a culture of your urine, blood, semen to look for the amount and type of bacterial growth. 

Types of bacterial infections (1,2,3,4)

Some of the different types bacteria that could affect your reproductive health include Chlamydia trachomatis, Neisseria gonorrhoeae, Escherichia coli, Pseudomonas aeruginosa, Brucella, Mycobacterium tuberculosis, Streptococcus faecalis, Enterococcus faecalis, Staphylococcus aureus, and Ureaplasma urealyticum.

Chlamydial infections are the most common bacterial sexually transmitted infections.  Some don’t show any symptoms and others could have inflammation of the urethra (urethritis), inflammation of the epididymis (epididymitis), inflammation of prostate (prostatitis), testicular pain, yellowish discharge, pain when urinating (dysuria), tenderness of testicles(orchitis), and it is also found to affect sperm by decreasing sperm motility, affecting sperm morphology by breaking its chromosomes and also affect sperm count.  The transport of sperm could also be obstructed.

Neisseria gonorrhoeae is also prevalent and usually has symptoms which could cause urethritis, prostatitis, epididymis, dysuria, testicular pain, abnormal sperm production or reduced sperm fertilization, and urethral discharge. It could lead to temporary or even permanent damage to the site where sperm are produced.  Other symptoms could also include sore throat, redness of eyes, joint pain, and lesions.

Escherichia coli could cause urinary tract infections and could lead to inflammation of different organs including the ones in the reproductive system and could affect sperm quality and affect sperm production, prostatitis, urethritis, epididymo-orchitis or testicular pain.

Pseudomonas aeruginosa infection could lead to inflammation of the epididymis and urethra. It could also affect sperm motility.

Brucella can replicate, survive in the immune cells, and thus escape the immune response by the host. As a result, it can spread to the tissues and increase in the male reproductive system and can lead to orchitis and epididymitis.

Mycobacterium tuberculosis could cause infertility due to obstructions decreasing sperm numbers in the semen. 

Streptococcus faecalis could lead to less or no sperm in semen or poor quality sperm.

Staphylococcus aureus could cause poor quality semen, increase tissue damage and impair functions of the sperm and produce toxins that damage male reproductive tissue and cells.

Treatments

Antibiotics could treat most bacterial infections.  It’s important not to have sex during treatment and to complete the full dosage of medication to ensure that the infection clears up totally.  Its also important to check and retest three months after treatment to make sure the treatment has worked.  The partners should get tested as well.  Chances of contracting a sexually transmitted infection could be lessened by proper use of condoms and avoid having sex with anyone who has rash, genital sores or discharge.  You could also get vaccinated to prevent certain infections and have fewer partners. So, the main effects of bacterial infection to male fertility are inflammation of the reproductive system, injury to the various tissues/organs of the reproductive system, damage to sperm itself and negatively affecting sperm production.  To find out more information about bacterial infections and its role in male infertility, speak to the experts at Xenith Advanced Fertility Centre.

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    Dr. Mamta Dighe is the Founder and Director of Xenith Advanced Fertility Centre. She is an IVF Specialist in Pune, Maharashtra, India. She studied medicine at the prestigious Seth G S Medical College and KEM Hospital in Mumbai, one of the most elite Medical Institutions in India. She is amongst the first three doctors in India to achieve the Degree of Fellowship in Reproductive Medicine, a sub-speciality of Gynaecology. She is an IVF Specialist in PCMC and Pune who deals with infertility, hormone problems, menstrual problems and a wide spectrum of problems in adolescent, reproductive and menopausal women.

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