Can untreated chlamydia (Chlamydia trachomatis) cause watery semen and is it reversible?

Untreated Chlamydia and Watery Semen

Untreated chlamydia infection can cause low semen volume which may appear watery, and this condition is potentially reversible with appropriate antibiotic treatment. 1

Effects of Chlamydia on Male Reproductive System

Chlamydia trachomatis affects the male reproductive system in several ways:

• Chlamydia primarily causes urethritis in men, which may be symptomatic or asymptomatic 2
• The infection can spread to the epididymis and testes, causing epididymitis and orchitis 3
• Chlamydial infection may affect the prostate gland, with incidence rates of up to 39.5% reported in patients with prostatitis 3
• These infections can affect accessory glands that contribute to seminal fluid production 1

Connection Between Chlamydia and Watery Semen

Research has established several connections between chlamydial infection and semen quality:

• Chlamydia infection has been associated with low seminal volume (≤1.5 ml), which can appear watery (OR=2.1; CI95% 1.16-3.07) 1
• The reduced volume may result from obstruction of the ejaculatory duct or infection of accessory glands that contribute to seminal fluid 1
• In-vitro studies show that chlamydial lipopolysaccharide can directly damage sperm, affecting motility and causing premature sperm death 4
• Infection of the testis and prostate is implicated in deterioration of sperm quality 3

Prevalence and Detection

• Chlamydia is the most commonly diagnosed bacterial sexually transmitted infection globally 5
• The infection is asymptomatic in over 80% of cases, making detection challenging 5
• Studies have found Chlamydia trachomatis in approximately 31.9% of semen samples from male partners of infertile women 1
• The prevalence of chlamydial infection is similar in males and females, though research and screening have historically focused more on females 3

Reversibility with Treatment

• Chlamydial infections generally respond well to antibiotic treatment 2
• Recommended treatment regimens include:
  • Azithromycin 1g orally in a single dose, OR
  • Doxycycline 100mg orally twice daily for 7 days 2
• Early treatment before permanent damage occurs offers the best chance for reversing effects on semen quality 2
• Treatment of both the infected individual and their sexual partners is essential to prevent reinfection 2

Clinical Implications and Screening

• Men with unexplained watery semen or low seminal volume should be screened for chlamydia infection 1
• The proportion of male partners of infertile couples with evidence of chlamydial infection is greater than in the general population 3
• Untreated infections can persist for months, during which complications may develop and transmission to partners can occur 2
• Male chlamydial infection may also affect the fertility of the female partner 3

Pitfalls and Caveats

• Symptoms of chlamydial infection in men are often absent or mild, leading to delayed diagnosis and treatment 2
• The effects on semen quality may not be immediately apparent and could be confused with other causes of male infertility 3
• Even after successful treatment, some damage to the reproductive tract may persist if the infection was longstanding 3
• Laboratory testing is essential for diagnosis as symptoms alone are not reliable indicators of infection 6