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Infections like tuberculosis, mumps and sexually transmitted diseases like gonorrhea, chlamydia and syphilis can impact male infertility. Previously, the commonest cause of aazoospermia in India was smallpox. This particular infection injured the epididymis, and resulted in ductal obstruction. Fortunately, this disease is now history as it has been eradicated.
The silent disease
Tuberculosis also harms the epididymis, and causes azoospermia. However, making the right medical diagnosis of tuberculous epididymitis can be very difficult- this is a very silent and indolent disease. Sexually transmitted diseases including gonorrhea, Chlamydia and syphilis can also impact a man's genital system; it can lead to irreparable injury to its inner lining (epithelium).
Mumps might cause orchitis (inflammation of the testis). This is specifically when it impacts younger males. It can cause significant harm to the testes and if it damages both the ovaries, can cause testicular failure. Of course, not every boy who gets mumps will develop sperm problems once he reaches adulthood.
Other genital tract infections
Many patients (and of course their doctors!) worry when the patient’s semen analysis report shows pus cells/ white blood cells (WBCs).This condition is called pyospermia or leucocytospermia. Its important to keep in mind that its quite normal to find a few pus cells in the semen and this doesn’t mean you have any type of semen infection. In fact, fertile men too can have round cells in their semen.
These aren’t pus cells; they are sperm precursor cells (spermatocytes). However, most labs aren’t able to differentiate between pus cells and sperm precursor cells. They report these round cells as pus cells; the doctors will then start the patient on antibiotic treatment to “treat” this infection which is nothing but a waste of time and money.
When the semen sample contains numerous pus cells, many doctors also perform a semen culture. If the examination is positive, they then start the patient on antibiotic therapy. However, many of the organisms grown in these culture reports aren’t really pathogenic organisms at all; they are just normal commensals that colonize the genital tract; normal fertile men have these too.
Not much clarity
In short, there isn’t much clarity about the connection between the presence of bacteria inside the semen and male infertility. Do these bacteria actually cause infertility and will dealing with that infection help improve fertility? Again, there are just too many questions and very few answers. In my opinion, treating most of these "abnormal reports" does not help to improve the man's fertility at all.
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