Can Helicobacter pylori (H. pylori) infection affect male sperm quality?

Helicobacter pylori Infection and Male Sperm Quality

There is no established evidence that Helicobacter pylori infection affects male sperm quality, as current guidelines do not recognize any association between H. pylori and male reproductive function. 1

Current Evidence on H. pylori and Extragastric Manifestations

• The Maastricht IV/Florence Consensus Report specifically identifies only three confirmed extragastric manifestations of H. pylori infection: iron-deficiency anemia, idiopathic thrombocytopenic purpura (ITP), and vitamin B12 deficiency 1
• Guidelines state that "the evidence available shows no unequivocal causative association between H. pylori and other extragastric disorders," beyond those specifically mentioned 1
• Male reproductive health and sperm quality are not mentioned among the established or suspected extragastric manifestations of H. pylori infection in any of the major guidelines 1

Known Extragastric Effects of H. pylori

• H. pylori infection has been definitively linked to:
  • Iron-deficiency anemia (Evidence level: 1a, Grade of recommendation: A) 1
  • Idiopathic thrombocytopenic purpura (Evidence level: 1b, Grade of recommendation: A) 1
  • Vitamin B12 deficiency (Evidence level: 3b, Grade of recommendation: B) 1
• H. pylori infection has also been shown to affect drug bioavailability, specifically:
  • Thyroxine absorption 1
  • L-dopa absorption 1
• However, none of these established extragastric effects involve the male reproductive system 1

Male Infertility Considerations

• The AUA/ASRM guidelines on male infertility do not mention H. pylori infection as a factor affecting male fertility or sperm quality 1
• Known factors affecting male fertility include:
  • Hormonal disorders (hypogonadotropic hypogonadism) 1
  • Varicocele 1
  • Genetic factors 1
  • Certain medications and environmental exposures 1
  • But H. pylori is not included in this list 1

Clinical Implications

• For men concerned about fertility:
  • Standard fertility evaluations should focus on established causes of male infertility 1
  • Testing for H. pylori is not indicated as part of a male fertility workup based on current evidence 1
• For patients with H. pylori infection:
  • Eradication therapy should be considered for established indications (peptic ulcer disease, gastric MALT lymphoma, atrophic gastritis, etc.) 1, 2, 3
  • But improvement in sperm quality is not an expected outcome of H. pylori eradication 1

Conclusion

• Current medical guidelines do not support testing for or treating H. pylori infection specifically to address male fertility concerns 1
• Men experiencing fertility issues should undergo standard fertility evaluations focusing on established causes of male infertility rather than H. pylori testing 1
• More research would be needed to establish any potential relationship between H. pylori infection and male reproductive function 1