Chlamydia and Male Infertility
Yes, chlamydia can cause infertility in men, with recent meta-analysis showing that chlamydia infection increases the risk of male infertility by 2.28 times, and affects approximately 20.6% of infertile males. 1
Mechanism of Infertility in Men
Chlamydia trachomatis can affect male fertility through several mechanisms:
Direct damage to sperm: Chlamydial infection impairs sperm parameters, increases DNA fragmentation, and reduces acrosome reaction capacity 2
Reproductive tract damage: Infection can cause:
- Urethritis
- Epididymitis (which can occur particularly in adolescent and young adult males)
- Orchitis
- Possibly prostatitis (controversial but with incidences up to 39.5% reported in patients with prostatitis) 2
Long-term complications: In some cases, chlamydial infection can lead to irreversible total azoospermia 3
Prevalence and Risk
- The prevalence of chlamydial infection is similar in males and females 2
- 70-90% of men with chlamydia are asymptomatic, making detection difficult without screening 4, 5
- The proportion of male partners in infertile couples with evidence of chlamydia infection is greater than in the general population 2
Impact on Fertility
- A 2023 meta-analysis found that chlamydia infection significantly increases the risk of male infertility with an odds ratio of 2.28 (95% CI: 1.90-2.72) 1
- Chlamydia-positive men show altered sperm vitality with an odds ratio of 2.41 (p=0.02,95% CI: 1.15-5.06) 3
- Male chlamydial infection may also affect the fertility of the female partner 2
Screening and Detection
- Unlike for women, routine screening recommendations for men are less established
- The USPSTF found insufficient evidence to recommend routine screening for chlamydia in men (I statement) 4
- However, screening high-risk young men is considered a clinical option 4
Prevention and Treatment
- Early detection and treatment is crucial to prevent long-term fertility complications
- Partners of infected individuals should be tested and treated if infected or treated presumptively 4
- CDC-recommended treatments include:
- Doxycycline 100 mg orally twice daily for 7 days
- Azithromycin 1 g orally in a single dose 5
Clinical Implications
- Men with unexplained infertility should be evaluated for possible chlamydial infection
- Those previously infected should be rescreened at 6-12 months due to high reinfection rates 5
- Proper treatment can prevent further damage to the reproductive system, though some damage may be irreversible
Caveat
Some older research has questioned the role of asymptomatic chlamydial infection in male infertility. A small 1987 study found no evidence for a role of asymptomatic mycoplasma or chlamydial infection in male infertility 6. However, more recent and comprehensive studies with larger sample sizes have established a significant association between chlamydia infection and male infertility.