**4. Symptoms, diagnosis and treatment of the infection**

CP due to CT infection is found to have a significant impact on young male fertility. The main challenge in the chlamydial infection is up to 50% men have asymptomatic infection [46]. Many young people at risk for of CT infection may not seek sexual health care due to the asympto‐ matic nature of the bacterial infection [47]. HBV infection symptoms include nausea, anorexia, vomiting, flu-like complaints, fatigue, vasculitis, immune complex nephritis, and polyarteritis nodosa. There are approximately 5 % of adults (especially men) develop chronic HBV infection, which is often asymptomatic [32].

#### **4.1. Diagnosis**

MG can be found using real-time PCR technique or cell culture. MG culture is time consuming and slow process, and it requires cocultivation in Vero or equivalent cells [26]. Acute HBV infection has an incubation period of 6 weeks to several months. Most of the infected adults will show elevations in Alanine aminotransferase (ALT). Patients with acute HBV infection are mostly seropositive for anti-HBc-IgM antibody, and hepatitis B e antigen (HBeAg) marker correlates with high infectivity. The presence of antibody to HBeAg (anti HBe) shows a less infectious state and also HBV-DNA in serum or plasma indicates active HBV infection [50].

#### **4.2. Treatment**

Antibiotic therapy in the eradication of *C. trachomatis* infection does not always result in recovery of semen quality. Prulifloxacin is a drug used to treat patients with CP. Combination of antibiotic drugs and phytotherapeutic agents, such as FERTIMEV, can improve the clinical efficacy of prulifloxacin. l-arginine, l-carnitine, and acetyl-l-carnitine are found to be effective in increas‐ ing semen quality, can stimulate the activity of endothelial nitric oxide (NO) synthase, and can enhance sperm motility and function. NO synthase appears to be involved in sperm motility, metabolism, and capacitation. l-arginine in spermatozoa is a source of NO [29].

Based on Centers for Disease Control and Prevention and the Australasian Sexual Health Alliance, 1 g of azithromycin is generally recommended as standard treatment for MG due to its superior cell penetration efficiency. There is an association between MG organism load and azithromycin treatment failure [50]. However there is also an evidence of azithromycin, treatment failure is found due to macrolide resistance mutations. Single nucleotide polymor‐ phisms (SNPs) in region V of the 23S rRNA gene of MG were found to be strongly associated with increased MICs to azithromycin in clinical isolates and treatment failure [28]. Moxiflox‐ acin, doxycycline, gatifloxacin, and sitafloxacin are used as second-line treatment for MG [48]. However, its considerable expense and risk of serious adverse events, including hepatotoxic‐ ity, make this agent unsuitable for initial treatment. Recent study shows that single-dose azithromycin therapy is better than doxycycline therapy in the treatment of MG [51].

Lamivudine, one of the novel antiviral agents, is a deoxycytosine analog, which inhibits HBV DNA synthesis and suppresses serum HBV DNA levels in chronic hepatitis B (CH-B) patients. A significant enhancement in CD4-mediated T cell response to HBV nucleocapsid antigen was detectable after lamivudine treatment. One of the most effective treatments for CH-B is interferon (IFN) therapy [35].

Active vaccination is highly effective in preventing HBV infection. *Active prophylaxis* is a recombinant vaccine. Recombivax HB and Engerix-B are the commercial products available [32]. Successful vaccination strategies have led to significant decrease in HBV prevalence [36]. In case of adult patients, 90% of them recover from HBV infection. However, 90% HBV-affected children ≤4 years of age develop chronic infection [32].
