**2. Types of genital tract infections that may cause infertility**

Epididymitis usually caused by gonorrhea, tuberculosis, chlamydia, urea plasmas, *Pseudomo‐ nas*, and coliform. Orchitis usually caused by mumps and tuberculosis. Tuberculosis and trichomoniasis are implicated in seminal vesiculitis. Urethritis usually caused by gonorrhea, chlamydiae, ureaplasmas, and trichomoniasis [5–10].

Many infectious organisms can affect fertility. These organisms include bacteria, viruses, yeasts, parasites, tropical infections, and other rare conditions.

#### **2.1. Bacterial infections**

Urethritis caused by *Neisseria gonorrhea* can affect fertility only if the testes were affected in rare situations. After the human immunodeficiency virus (HIV) epidemic in Western countries, more sexual precautions and hygiene were adopted, and this lead to marked decrease in the incidence of *N. gonorrhea* infection in the male genital tract [5].

*Chlamydia trachomatis* can affect both sexes but has a much greater impact on females than on males. Chlamydial infections may remain silent [6]. In men, *C. trachomatis* is the most common agent of nongonococcal urethritis, particularly serovars D and K and may cause epididymitisorchitis, prostatitis, and sperm tract obstruction, in this way, impairing male fertility [7]. When *Chlamydia trachomatis* incubated with human spermatozoa in vitro, it seems to impair sperm motility, and cause premature death, perhaps as an effect of the chlamydial lipopolysaccharide [8]. There is evidence that an infection by trachomatis is related to the production of antisperm antibodies (ASA) that may affect fertility [9]. Also, an infected male partner, even if asympto‐ matic may transmit the infection to his female partner [10]. Also, results of human and animal inoculation studies support the notion that ureaplasmas are a cause of nonchlamydial and nongonococcal urethritis (NGU) in men [11]. According to a study, overnight incubation with *Mycoplasma* hominis can produce small but statistically significant differences in motility, morphology, and fertilization potential inhuman spermatozoa [12]. In addition, *Urea plasma urealyticum* is associated with the production of reactive oxygen species [13].

*Escherichia coli* are the most common cause of nonsexually transmitted epididymo-orchitis and are involved in the 65–80% of total acute or chronic prostatitis cases. *E. coli* may, therefore, be implicated in the genesis of infertility [14].

### **2.2. Viral infections**

itself can be affected by urogenital infections at different levels of development, maturation, and transport of spermatozoa. These infections can be both sexually transmitted and nonsexually transmitted. Among the most common microorganisms involved in sexually trans‐ mitted infections, thus interfering with male fertility, are the *Chlamydia trachomatis* and *Neisseria gonorrhea*. Less frequently, male infertility may be due to nonsexually transmitted epididymoorchitis, mostly caused by *Escherichia coli*. Infections of the lower genital tract seem to have little importance. However, such infections, as well as those involving other parts of the male

Epididymitis usually caused by gonorrhea, tuberculosis, chlamydia, urea plasmas, *Pseudomo‐ nas*, and coliform. Orchitis usually caused by mumps and tuberculosis. Tuberculosis and trichomoniasis are implicated in seminal vesiculitis. Urethritis usually caused by gonorrhea,

Many infectious organisms can affect fertility. These organisms include bacteria, viruses,

Urethritis caused by *Neisseria gonorrhea* can affect fertility only if the testes were affected in rare situations. After the human immunodeficiency virus (HIV) epidemic in Western countries, more sexual precautions and hygiene were adopted, and this lead to marked decrease in the

*Chlamydia trachomatis* can affect both sexes but has a much greater impact on females than on males. Chlamydial infections may remain silent [6]. In men, *C. trachomatis* is the most common agent of nongonococcal urethritis, particularly serovars D and K and may cause epididymitisorchitis, prostatitis, and sperm tract obstruction, in this way, impairing male fertility [7]. When *Chlamydia trachomatis* incubated with human spermatozoa in vitro, it seems to impair sperm motility, and cause premature death, perhaps as an effect of the chlamydial lipopolysaccharide [8]. There is evidence that an infection by trachomatis is related to the production of antisperm antibodies (ASA) that may affect fertility [9]. Also, an infected male partner, even if asympto‐ matic may transmit the infection to his female partner [10]. Also, results of human and animal inoculation studies support the notion that ureaplasmas are a cause of nonchlamydial and nongonococcal urethritis (NGU) in men [11]. According to a study, overnight incubation with *Mycoplasma* hominis can produce small but statistically significant differences in motility, morphology, and fertilization potential inhuman spermatozoa [12]. In addition, *Urea plasma*

*Escherichia coli* are the most common cause of nonsexually transmitted epididymo-orchitis and are involved in the 65–80% of total acute or chronic prostatitis cases. *E. coli* may, therefore, be

genital urinary tract, may cause a microbial colonization of the semen [4].

**2. Types of genital tract infections that may cause infertility**

chlamydiae, ureaplasmas, and trichomoniasis [5–10].

**2.1. Bacterial infections**

64 Genital Infections and Infertility

yeasts, parasites, tropical infections, and other rare conditions.

incidence of *N. gonorrhea* infection in the male genital tract [5].

*urealyticum* is associated with the production of reactive oxygen species [13].

implicated in the genesis of infertility [14].

Adverse semen analysis parameters (poor sperm count and reduced motility) have been reported in infertile patients with positive herpes simplex virus (HSV) in semen. These adverse parameters were reversed after initiation of antiviral treatment [15].

Human papilloma virus (HPV) was found in testicular biopsies of azoospermic men, and when present inside sperm cells, they may be related to impaired sperm motility and asthenozoo‐ spermia [16]. It was found that there is an association between HPV and infertility, particularly between the presence of these agents and tubal factor infertility that cause a sort of infertility [16]. HIV may impair semen production by itself and certainly deteriorates the outcome of concomitant genital infections; in addition, the specific anti-HIV therapies can cause serious effects on the male reproductive system [17].

#### **2.3. Fungal infections**

*Candida albicans* commonly colonizes the urethra. It can be found in the semen and may affect in vitro fertilization. *C. albicans* has an inhibitory effect on human sperm motility and impairs the ultrastructure of human spermatozoa, which could be associated with male infertility [18].

#### **2.4. Protozoa infections**

*Trichomonas vaginalis* is a common parasite of the male genital tract. The organism can, in rare cases, cause a nongonococcal urethritis, prostatitis, and other genital tract disorders. Protei‐ nases released by *T. vaginalis* can also inhibit sperm motility in vitro, even after the microor‐ ganism has been removed from the culture medium [19].
