Co-Occurrence of Seminal Bacteriospermia, Sperm Functional Impairment, and Anti-Sperm Antibody Positivity in Male Infertility: A Case-Control Study

Document Type : Original Article

Authors

1 1Medical Laboratory Department, Sulaimani polytechnic University, Kurdistan Region of Iraq

2 Lecturer in Medical Laboratory Department, Sulaimani polytechnic University, Kurdistan Region of Iraq.

10.22038/psj.2025.90631.1483

Abstract

Introduction:
Bacterial infections and anti-sperm antibodies (ASA) are significant factors contributing to male infertility. This study examines the relationship between bacterial infection and ASA presence in the seminal fluid of infertile males.
Materials and Methods:
A case-control study was conducted from January to December 2023 at Dr. Nyaz Omer Rostam Clinic, Sulaymaniyah, Iraq. Eighty married men aged 20–40 years with abnormal semen analysis were enrolled and divided into two groups: 40 with confirmed bacterial infections (case group) and 40 without (control group). Semen analysis, bacterial culture, and MAR test for ASA were performed according to WHO 2021 guidelines.
Results:
The case group (CG) (n=40) exhibited significantly lower sperm motility (30.10% ± 12.05 vs. 44.48% ± 4.60; p ≤ 0.001), viability (55.78% ± 8.04 vs. 63.95% ± 6.26; p ≤ 0.001), and normal morphology (3.05 ± 1.44 vs. 4.78 ± 0.768; p ≤ 0.001) compared to controls (n=40). Semen volume was higher in the CG (3.85 ± 1.69 mL vs. 3.18 ± 1.29 mL; p = 0.05). No significant differences were observed in sperm concentration or total sperm count. Bacterial cultures were positive in 40 (100%) of the CG, with Enterococcus faecalis detected in 10 (25%) and Staphylococcus haemolyticus in 8 (20%), while all controls (0%) were negative (p ≤ 0.001). MAR test positivity (≥30%) was observed in all of the CG and in none of the controls (0%) (p ≤ 0.001).
Conclusion:
The present study demonstrated that bacterial infections in the semen of infertile men are significantly associated with reduced sperm quality (especially motility, viability, and normal morphology.

Keywords

Main Subjects


  1. Leslie SW, Soon-Sutton TL, Khan MAB. Male Infertility. StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Taylor Soon-Sutton declares no relevant financial relationships with ineligible companies. Disclosure: Moien AB Khan declares no relevant financial relationships with ineligible companies.2025.
  2. Bach PV, Schlegel PN. Chapter 23 - Male Infertility. In: Strauss JF, Barbieri RL, editors. Yen and Jaffe's Reproductive Endocrinology (Eighth Edition). Philadelphia: Elsevier; 2019. p. 582-93.e2.
  3. Khambata K, Modi DN, Gupta SK. Immunoregulation in the testis and its implication in fertility and infections. Exploration of Immunology. 2021;1:309-24. https://doi.org/10.37349/ei.2021.00021.
  4. Eini F, Kutenaei MA, Zareei F, Dastjerdi ZS, Shirzeyli MH, Salehi E. Effect of bacterial infection on sperm quality and DNA fragmentation in subfertile men with Leukocytospermia. BMC Molecular and Cell Biology. 2021;22(1):42. https://doi.org/10.1186/s12860-021-00380-8.
  5. Eini F, Kutenaei MA, Zareei F, Dastjerdi ZS, Shirzeyli MH, Salehi E. Effect of bacterial infection on sperm quality and DNA fragmentation in subfertile men with Leukocytospermia. BMC Mol Cell Biol. 2021;22(1):42. 10.1186/s12860-021-00380-8. PMC8364116.
  6. Babandi RM, Ibraheem RS, Garba RM, Liman IM, Ismail-Are A, Samuel Y. Does seminal fluid bacterial isolate(s) affect in vitro fertilization — embryo transfer outcome? Middle East Fertility Society Journal. 2023;28(1):8. https:// doi.org/ 10. 1186/s43043-023-00132-y.
  7. Tvrdá E, Ďuračka M, Benko F, Lukáč N. Bacteriospermia - A formidable player in male subfertility. Open life sciences. 2022;17(1):1001-29. https://doi.org/10.1515/biol-2022-0097. PMC9386612.
  8. Sciorio R, De Paola L, Notari T, Ganduscio S, Amato P, Crifasi L, et al. Decoding the Puzzle of Male Infertility: The Role of Infection, Inflammation, and Autoimmunity. Diagnostics. 2025;15(5):547.
  9. Abdullah SMZ. Relationship Between Post-Pubertal Mumps Infection In Males With Infertilityand Its Effect on The Result of Seminal Fluid Analysis and Occurrence of Immunological Infertility. Diyala Journal of Medicine. 2020; 19(2):118-28.
  10. Restrepo B, Cardona-Maya W. Antisperm antibodies and fertility association. Actas urologicas espanolas. 2013;37(9):571-8. https://doi.org/10.1016/j.acuro.2012.11.003.
  11. Gholami M, Moosazadeh M, Haghshenash MR, Jafarpour H, Mousavi T. Evaluation of the Presence of Bacterial and Viral Agents in the Semen of Infertile Men: A Systematic and Meta-Analysis Review Study. Frontiers in medicine. 2022; 9:835254. https:// doi.org/ 10.3389/ fmed. 2022.835254. PMC9116196.
  12. WHO. WHO Laboratory manual for the examination and processing of human semen. 6th ed. Cambridge, UK: Cambridge University Press. 2021.
  13. Leathersich S, Hart RJ. Immune infertility in men. Fertility and Sterility. 2022;117(6):1121-31. https://doi.org/10.1016/j.fertnstert.2022.02.01014. Kuntareddi C, Elango K, Nag P, Kumaresan A. Impact of antisperm antibodies on sperm functions and fertility in livestock: A narrative review. Asian Pacific Journal of Reproduction. 2024;13(6):251-60. 10.4103/apjr.apjr_175_24.
  14. Farsimadan M, Motamedifar M. Bacterial infection of the male reproductive system causing infertility. Journal of Reproductive Immunology. 2020;142:103183. https:/ /doi.org/ 10.1016/j. jri.2020.103183.
  15. Gholami M, Moosazadeh M, Haghshenash MR, Jafarpour H, Mousavi T. Evaluation of the Presence of Bacterial and Viral Agents in the Semen of Infertile Men: A Systematic and Meta-Analysis Review Study. Frontiers in Medicine. 2022; Volume 9 - 2022. 10.3389/fmed.2022.835254.
  16. Neto FTL, Viana MC, Cariati F, Conforti A, Alviggi C, Esteves SC. Effect of environmental factors on seminal microbiome and impact on sperm quality. Frontiers in Endocrinology. 2024; Volume 15 - 2024. 10.3389/fendo.2024.1348186.
  17. Chatzokou D, Tsarna E, Davouti E, Siristatidis CS, Christopoulou S, Spanakis N, et al. Semen Microbiome, Male Infertility, and Reproductive Health. International Journal of Molecular Sciences. 2025;26(4):1446.
  18. Akhigbe RE, Dutta S, Hamed MA, Ajayi AF, Sengupta P, Ahmad G. Viral Infections and Male Infertility: A Comprehensive Review of the Role of Oxidative Stress. Front Reprod Health. 2022;4:782915. 10.3389/frph.2022.782915. PMC9580820.
  19. Pereira R, Sousa M. Morphological and Molecular Bases of Male Infertility: A Closer Look at Sperm Flagellum. Genes (Basel) [Internet]. 2023 2023/02; 14(2):[383 p.]. Available from: https://europepmc.org/articles/PMC9956255.
  20. Ahmadian Mahmoudabadi M, Ghorbanmehr N, Movahedin M, Elikaei A. Effects of Escherichia coli and Staphylococcus aureus Inoculation on Human Sperm Parameters. Navid No. 2020;23(73):1-13. 10.22038/nnj.2020.43544.1186.
  21. Wang Y, Fu X, Li H. Mechanisms of oxidative stress-induced sperm dysfunction. Front Endocrinol (Lausanne). 2025;16:1520835. 10.3389/fendo.2025.1520835. PMC11835670.
  22. Volz Y, Ebner B, Pfitzinger P, Berg E, Lellig E, Marcon J, et al. Asymptomatic bacteriospermia and infertility-what is the connection? Infection. 2022;50(6):1499-505. 10.1007/s15010-022-01828-5. PMC9705509.
  23. Pai MO, Venkatesh S, Gupta P. The role of infections in infertility: A review. International Journal of Academic Medicine. 2020;6(3):189-96. 10.4103/ijam.Ijam_44_19.
  24. Alzaidi JR, Kareem AA. The Impact of Urogenital Tract Infectious Bacteria on Male Fertility. Medical Journal of Babylon. 2024; 21(2): 476-80. 10.4103/mjbl.Mjbl_75_24.
  25. Gupta S, Sharma R, Agarwal A, Boitrelle F, Finelli R, Farkouh A, et al. Antisperm Antibody Testing: A Comprehensive Review of Its Role in the Management of Immunological Male Infertility and Results of a Global Survey of Clinical Practices. World J Mens Health. 2022;40(3):380-98. 10.5534/wjmh.210164. PMC9253805.
  26. Mukherjee AG, Gopalakrishnan AV. Anti-sperm Antibodies as an Increasing Threat to Male Fertility: Immunological Insights, Diagnostic and Therapeutic Strategies. Reproductive Sciences. 2024; 31(11):3303-22. 10.1007/s43032-024-01610-y.
  27. Falcone M, Bocu K, Keskin H, Solorzano Vazquez JF, Banthia R, Mahendran T, et al. Anti-sperm Antibody Positivity in Men with Varicocele: A Systematic Review and Meta-Analysis. World J Mens Health. 2025;43(1):60-9. 10.5534/ wjmh. 240003. PMC11704166.
  28. Acharyya S. Immune and endocrine aspects of the testis and its relation to male infertility. Chemical Biology Letters. 2021;8(4):144-61.
  29. Silva AFN. Antisperm antibodies-related infertility: New insights on sperm functionality: Universidade de Coimbra; 2024.
  30. Vashisht A, Gahlay GK. Understanding seminal plasma in male infertility: emerging markers and their implications. Andrology. 2024;12(5):1058-77. https://doi.org/10.1111/andr.13563.
  31. Fehringer M, Vogl T. Molecular mimicry in the pathogenesis of autoimmune rheumatic diseases. J Transl Autoimmun. 2025;10:100269. 10. 1016/ j. jtauto.2025.100269. PMC11773492.
  32. Parida R. Human MOSPD2: A bacterial Lmb mimicked auto-antigen is involved in immune infertility. J Transl Autoimmun. 2019;1:100002. 10.1016/j.jtauto.2019.100002. PMC7388392.