Asymptomatic Chlamydia and Male Infertility
Asymptomatic chlamydial infections in men rarely result in infertility, although they can cause epididymitis which may potentially lead to infertility in some cases. 1
Relationship Between Chlamydia and Male Fertility
According to the CDC guidelines, chlamydial infections among men rarely result in sequelae (long-term complications) 2. While chlamydia is a common cause of urethritis in men, the infection is often asymptomatic or presents with mild symptoms 2. This is in stark contrast to women, where untreated chlamydial infections can lead to significant reproductive health complications.
The potential mechanisms by which chlamydia might affect male fertility include:
- Epididymitis - Chlamydia trachomatis can cause epididymitis, which in some cases may lead to infertility 1
- Urethritis - Chlamydia accounts for 30-40% of nongonococcal urethritis cases in men 2
Evidence Assessment
The evidence regarding asymptomatic chlamydia causing male infertility shows mixed results:
- Older research from 1987 found "no evidence for a role of current asymptomatic mycoplasma or chlamydial infection in male infertility" 3
- More recent research from 2018 suggests that "asymptomatic infection caused by C. trachomatis is correlated with male infertility and antibiotic therapy can improve the semen quality" 4
However, the most authoritative and recent guidelines from the CDC and other public health authorities maintain that chlamydial infections in men rarely result in sequelae that affect fertility 2, 1.
Clinical Implications
For men with asymptomatic chlamydia:
- The primary concern is not their own fertility but the risk of transmitting the infection to female partners, who face more serious reproductive health consequences 2
- Asymptomatic infected men may unknowingly infect their sex partners before seeking treatment 2
- Treatment is important to prevent transmission, even if the risk to male fertility is low
Screening and Treatment Recommendations
- The CDC recommends screening of sexually active young men in high-prevalence settings such as adolescent clinics, correctional facilities, and STD clinics 1
- Recommended treatment regimens include:
- Azithromycin 1g orally in a single dose, OR
- Doxycycline 100mg orally twice daily for 7 days 1
Important Caveats
- While the risk to male fertility appears low, untreated chlamydia in men serves as a reservoir for infection of female partners
- Female partners of infected men are at high risk for developing PID, tubal scarring, and infertility if they become infected 2
- All sexual partners within the preceding 60 days should be evaluated and treated to prevent reinfection 1
In conclusion, while asymptomatic chlamydia infection in men poses a relatively low risk to their own fertility, prompt diagnosis and treatment remain essential to prevent transmission to female partners and the potential serious reproductive consequences that may follow.