CEF曼谷生殖中心：男性泌尿生殖道感染

Article: Infections in Male Infertility

文章：病菌感染导致的男性不育症

Author: Ralf Henkel

Book: Medical Surgical Management of MALE INFERTILITY

书籍：男性不孕症的内外科治疗

Editors: Botros RMB Rizk

Nabil Aziz

Ashok Agarwal

Edmund Sabanegh Jr

主编： Botros RMB Rizk

Nabil Aziz

Ashok Agarwal

Edmund Sabanegh Jr

The most prevalent pathogens of male urogenital tract infections are Chlamydia trachomatis, Ureaplasma urealyticum, Neisseria gonorrheae, Mycoplasma hominis, Mycoplasma genitalium or Escherichia coli. While the first pathogens are sexually transmitted, E. Coli is regarded as the most common cause of nonsexually transmitted urogenital tract infection.

引起男性泌尿生殖道感染最常见的病原体是沙眼衣原体、解脲支原体、淋球菌、人形支原体、生殖支原体或大肠杆菌。这些病原体的主要传播方式是性传播，而在非性播方式中，大肠杆菌被认为是引起泌尿生殖道感染的最常见原因。

Chlamydia trachomatis

沙眼衣原体

Chlamydia trachomatis is one of the most frequently sexually transmitted bacterial pathogens accounting to an estimated 92 Mil. new urogenital infections per year (1). In men, C. trachomatis has been detected in the testis, prostate (2) and even epididymis and seminal vesicles (3) thus causing orchitis, prostatitis, epididymitis and urethritis. Apart from the lesions triggered by the infection and its implications an acute inflammation can cause in the male genital tract, reports on the influence of Chlamydia infections on male fertility are inconsistent. While some authors (4) found no significant association, most others have shown a direct negative influence of the chlamydial infection on male fertility (5).

沙眼衣原体是最常见的通过性传播的细菌病原体之一，每年大概有9200万新发泌尿生殖系统感染（1）。沙眼衣原体可以感染男性的睾丸、前列腺（2）甚至附睾和精囊（3）。除了沙眼衣原体感染引发的病变及其影响外，沙眼衣原体还可能引起男性生殖道急性炎症。不同研究对于衣原体感染对男性生育力是否有影响的观点不一致，部分研究人员（4）发现两者之间没有显著关联，但大多数研究人员都表明衣原体感染对男性生育力有直接负面影响（5）。

Ureplasma urealyticum

解脲支原体

Ureaplasma urealyticum causes nongonococcal urethritis, pelvic inflammatory disease or infertility. A recent study (6) clearly showed these infections cause higher seminal viscosity, decreased sperm concentrations and lower pH. Additionally, Potts. et al. (7) revealed significantly increased seminal reactive oxygen species and Reichart et al. (8) higher levels of sperm DNA damage.

解脲支原体引起非淋菌性尿道炎、盆腔炎或不孕症。近期一项研究（6）明确发现解脲支原体的感染会导致精液浓度升高，精子浓度降低，pH值降低。此外，Potts等人（7）发现精液感染导致精液活性氧显著增加，Reichart等人（8）发现感染引起精子DNA损伤程度增加。

Mycoplasma homonis, Mycoplasma genitalium

人形支原体，生殖支原体

Both M. homonis and M. genitalium are significantly associated with genitourinary infections. Frequencies of infection are with 10.8 percent for M. homonis and 5 percent for M. genitalium, respectively, lower than for other pathogens (9). Both species can attach to and penetrate human sperm plasma membrane (10), which might have a significant long-term impact on male fertility as well as on the onset of pregnancy and the health of the offspring.

人形支原体和生殖支原体都与泌尿生殖系统感染显著相关，人群中的感染几率分别是10.8%和5%，低于其他病原体（9）。这两种细菌都可以附着并穿透人精子精浆膜（10），对男性生育力、早期妊娠和后代的健康可能会产生重大的长期影响。

Neisseria gonorrhoeae

淋球菌

Neisseria gonorrhoeae are gram-negative, immotile cocci growing in pairs. They cause the most common infectious disease in men leading to urethritis, prostatitis and epididyitis which in turn may impair male fertility. These bacteria have pili on their surface which facilitate attachment to other cells (11), which, in sperm, may bind to an asialoglycoprotein receptor that recognized and binds lipopolysaccharides in gonococcal membranes (12).

淋球菌是是一种革兰氏阴性菌，是不能游动的双球菌。男性最常见的传染病是由淋球菌感染引起的，会导致尿道炎、前列腺炎和附睾炎，进而可能损害男性生育力。淋球菌的表面有菌毛，有助于其附着在其他细胞上（11）。精子中有一种去唾液酸糖蛋白受体，能识别并结合淋球菌膜中的脂多糖，可能使淋球菌与这种受体结合（12）。

Even though its incidence has been declining in Western countries during the past decades, 150-400 new infections per 100,000 are still recorded in Europe per year (11). Presumably due to socioeconomic and behavioral factors, these numbers are much higher in third world and developing countries (13).

过去几十年里，西方国家的淋病发病率一直在下降，但欧洲每年每一百万人中仍有150-400例新感染（11）。可能是因为社会经济和行为因素，第三国家和发展中国家每年新感染数量比西方国家要高得多。

Escherichia coli

大肠杆菌

Escherichia coli, a gram-negative bacterium, is responsible for most urogenital tract and male accessory gland infections. In contrast to other pathogens E. Coli has significant direct negative effects on sperm motility and acrosome reaction (14). The latter might be due to morphological alterations, particularly on the acrosome and flagellum, seen after exposure of human sperm to the pathogen (15). E. Coli directly interacts with the sperm plasma membrane by means of bacterial pili. Schulz et al. (16) demonstrated two mechanisms by which the bacterium affects spermatozoa, the described direct interaction and by action of soluble factors that induce apoptosis and a breakdown in the mitochondrial membrane potential.

大肠杆菌是一种革兰氏阴性菌，是大多数泌尿生殖道和男性附属腺感染的病因。与其他病原体相比，大肠杆菌对精子活力和顶体反应有显著的直接负面影响（14）。对后者的影响可能是由于人类精子暴露于病原体后引起形态学改变，特别是顶体和鞭毛上的改变（15）。大肠杆菌通过细菌菌毛直接与精子精浆膜相互作用。Schulz等人（16）发现大肠杆菌影响精子的两种机制，即直接相互作用和通过溶性因子诱导细胞凋亡和破坏线粒体膜电位的方式。

Viruses

病毒

A number of viruses are also able to infect all parts of the male genital system, e.g. the testes (mumps virus, HIV 1), epididymis (Coxsackie virus), seminal vesicle (cytomegalovirus), prostate (HPV, HSV, HIV 1) and the semen (e.g. HSV, HPV, HIV) (17). Some of these viral infections are associated with poor semen and sperm quality.

许多病毒也能感染男性生殖系统，包括睾丸（腮腺炎病素、HIV 1型病毒）、附睾（柯萨奇病毒）、精囊（巨细胞病毒）、前列腺（人乳头瘤病毒、单纯疱疹病毒、HIV病毒）和精子（例如单纯疱疹病毒、人乳头瘤病毒、HIV病毒）（17）。其中一些病毒会导致精液和精子质量变差。

References

参考文献

1. World Health Organization. Global prevalence and incidence of selected sexually transmitted diseases: overview and estimates. World Health Organization: Geneva, Switzerland, 2001.

2. Kadar A, Bucsek M, Kardos M, et al. Detection of Chlamydia trachomatis in chronic prostatitis by in situ hybridization (preliminary methodological report). Orv Hetil 1995;136:659-62.

3. Bornman MS, Ramuthaga TN, Mahomed MF, et al. Chlamydia infection in asymptomatic infertile men attending an andrology clinic. Arch Androl 1998;147:807-13.

4. Habermann B, Krause W. Altered sperm function of sperm antibodies are not associated with chlamydial antibodies in infertile men with leukocytospermia. J Eur Acad Dermato Venerol 1999;12:25-9.

5. Mazzoli S, Cai T, Addonisio P, et al. Chlamydia trachomatis infection is related to poor semen quality in young prostatitis patients. Eur Urol 2009 May 27.

6. Wang Y, Liang CL, Wu JQ, et al. Do Ureaplasma urealyticum infections in the genital tract affect semen quality? Asian J Androl 2006;8:562-8.7.

7. Potts JM, Sharma R, Rasqualotto F, et al. Association of ureaplasma urealyticum with abnormal reactive oxygen species levels and absence of leukocytospermia. J Urol 2000;163:1775-8.

8. Reichart M, Kahane I, Bartoov B. In vivo and in vitro impairment of human and ram sperm nuclear chromatin integrity by sexually transmitted Ureaplasma urealyticum infection. Biol Reprod 2000;63:1041-8.

9. Gdoura R, Kchaou W, Chaari C, et al. Ureaplasma urealyticum, Ureaplasma parvum, Mycoplasma hominis and Mycoplasma genitalium infections and semen quality of infertile men. BMC Infect Dis 2007;7:129.

10. Taylor-Robinson D. Mycoplasma genitalium – an update. Int J STD AIDS 2002;13:145-51.

11. Krause W. Male accessory gland infection. Andrologia 2008;40:113-6.

12. Harvey HA, Porat N, Campbell CA, et al. Gonococcal lipooligosaccharide is a ligand for the asialoglycoprotien receptor on human sperm. Mol Microbiol 2000;36:1059-70.

13. AVERT. Org. STD Statistics Worldwide. Available at http://www.avert.org/stdstatisticsworldwide.htm. (accessed on 09 September 2010)

14. Kohn FM, Erdmann I, Oede T, et al. Influence of urogenital infections on sperm functions. Andrologia 1998;30(Suppl 1):73-80.

15. Diemer T, Huwe P, Michelmann HW, et al. Escherichia coli-induced alterations of human spermatozoa. An electron microscopy analysis. Int J Androl 200;23:178-86.

16. Schulz M, Sanchez R, Soto L, et al. Effect of Escherichia coli and its soluble factors on mitochondrial membrane potential, phosphatidylserine translocation, virability, and motility of human spermatozoa. Fertil Steril 2009 Mar 24.

17. Dejucq N, Jegou B. Viruses in the mammalian male genital tract and their effects on the reproductive system. Microbiol Mol Biol Rev 2001;65:208-31.

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