Chlamydia and Its Effects on Semen Quality
Recent evidence suggests that Chlamydia trachomatis infection may improve sperm parameters when treated, but there is no clear evidence that it directly causes watery sperm or significantly impairs male fertility. 1
Relationship Between Chlamydia and Male Reproductive Health
Chlamydia trachomatis is one of the most prevalent sexually transmitted bacterial infections worldwide, but its impact on male fertility remains controversial:
- Unlike in women, where Chlamydia is a significant cause of tubal factor infertility, the evidence for Chlamydia as a major cause of male infertility is limited 2
- The majority of morbidity from Chlamydia in heterosexual men results from infection of female partners who develop sequelae, rather than from direct effects on male fertility 2
Effects on Semen Parameters
The evidence regarding Chlamydia's impact on semen quality is mixed:
- A recent case-control study highlighted that treatment of asymptomatic Chlamydia infection may improve sperm parameters, though it's unclear whether this improves conception rates 1
- However, a 2017 study found that human sperm exposed to C. trachomatis in vitro did not show differences in sperm motility, viability, DNA fragmentation, or other quality parameters compared to control samples 3
- A 2023 meta-analysis found a high prevalence of C. trachomatis in sperm and semen samples of infertile men, with infection associated with a significantly higher risk of infertility (OR: 2.28) 4
Clinical Manifestations in Men
Chlamydial infections in men typically present as:
- Urethritis (most common manifestation, often with mild or absent symptoms) 2
- Epididymitis (accounts for approximately 50% of outpatient visits for this condition among young men) 2
- Proctitis (common in men who engage in receptive anal intercourse) 2
Diagnosis and Treatment
If Chlamydia infection is suspected:
- Nucleic acid amplification tests (NAATs) are the most sensitive and specific tests, with first-void urine samples being appropriate for testing in men 2
- Treatment options include:
- Azithromycin 1g orally in a single dose
- Doxycycline 100mg orally twice daily for 7 days 2
Important Considerations
- While some in vitro studies suggest that co-incubation of spermatozoa with Chlamydia causes decline in motile sperm numbers and premature sperm death 5, animal studies have not shown significant effects on fertility parameters 6
- Chlamydial lipopolysaccharide has been suggested as a principal factor potentially leading to sperm apoptosis 5
- Epididymitis, a potential complication of Chlamydia, if severe and left untreated, could potentially affect testicular function 2
Prevention and Follow-up
- All sexual partners from the past 60 days should be evaluated and treated 2
- Individuals should abstain from sexual intercourse until 7 days after treatment completion 2
- Retesting approximately 3 months after treatment is recommended to prevent reinfection 2
While there is some evidence suggesting a correlation between Chlamydia infection and male infertility, the direct causative relationship with watery sperm specifically is not well established. Treatment of Chlamydia infection is important regardless, as it may improve overall reproductive health and prevent transmission to partners.