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Sexuell übertragbare Infektionen und männliche Fertilität

Sexually transmitted infections and male fertility

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Zusammenfassung

Hintergrund

Sexuell übertragbare Infektionen (STI) sind weltweit häufig und können Einschränkungen der Fertilität bewirken. Bei Frauen sind Entzündungen des kleinen Beckens mit hierdurch resultierender tubarer Sterilität hierdurch gut belegt; bei Männern wird der Einfluss von STI auf die Fertilität nach wie vor kontrovers diskutiert.

Fragestellung

Betrachtet werden die Auswirkungen verschiedener bakterieller und viraler STI auf die männliche Fertilität.

Material und Methode

Es erfolgte die Auswertung internationaler Literatur bis 30.04.2018, einschließlich Studien an größeren Kollektiven aus dem asiatischen Raum.

Ergebnisse

Zur Beeinflussung der männlichen Fertilität durch verschiedene bakterielle und virale STI ergibt sich weiterhin ein uneinheitliches Bild. Für den direkten oder indirekten Nachweis eines pathogenen Erregers allein konnte eine Auswirkung auf die Ejakulatqualität bisher nicht eindeutig gesichert werden; es bestehen jedoch Hinweise auf negative Auswirkungen durch Mykoplasmen und Ureaplasmen in großen asiatischen Kollektiven. Die Übertragung viraler Erreger (HPV [humanes Papillomavirus], HSV [Herpes-simplex-Virus], HBV [Hepatitis-B-Virus]) beeinträchtigt möglicherweise auch den Erfolg assistierter Reproduktionsmaßnahmen. Bei Betrachtung manifester, durch STI hervorgerufener entzündlicher Prozesse des männlichen Genitaltrakts (v. a. durch Chlamydien und Gonokokken) oder bei HIV(„human immunodeficiency virus“)-Infektion finden sich dagegen häufiger Einschränkungen der Ejakulatqualität.

Schlussfolgerungen

Bei männlichen Fertilitätsstörungen ist eine mikrobiologische Abklärung sinnvoll. Weitere Studien zur Auswirkung von STI auf die männliche Fertilität an größeren Kollektiven, v. a. auch kaukasischer Patienten, sind notwendig. Die Inanspruchnahme existierender präventiver Maßnahmen wie das Chlamydienscreening für junge Frauen und die HPV-Impfung auch für Jungen sollte intensiv gefördert werden.

Abstract

Background

Sexually transmitted infections (STI) are common worldwide and can cause impairment of fertility. In women pelvic inflammatory disease with subsequent tubal sterility is well-documented but the influence of STI on male fertility is still controversely discussed

Objective

The effects of various bacterial and viral STI on male fertility are discussed.

Material and methods

An evaluation of the international literature up to 30 April 2018 was carried out including studies on larger collectives from the Asiatic region.

Results

There is still an inconsistent picture of the influence of various bacterial and viral STI on male fertility. Direct or indirect evidence of the impact of a pathogen alone on the quality of ejaculates could not be clearly demonstrated; however, there are indications of a negative effect by Mycoplasma and Ureaplasma species in large Asiatic collectives. The transmission of viral pathogens, such as human papillomavirus (HPV), herpes simplex virus (HSV) and hepatitis B virus (HBV) possible impairs the success of assisted reproductive techniques. In contrast, manifest inflammatory processes of the male genital tract caused by STI (in particular Chlamydia and gonococci) or human immunodeficiency virus (HIV) infections often result in impairment of sperm qualtity.

Conclusion

In cases of male fertility disorders a microbiological clarification is recommended. Further studies on the effect of STI on male fertility in larger collectives are necessary, particularly for Caucasian populations. The utilization of existing preventive measures, such as screening for Chlamydia in young women and HPV vaccination also for young males, should be intensively promoted.

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Authors and Affiliations

  1. Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland

    P. Spornraft-Ragaller

  2. Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland

    D. Varwig-Janßen

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  1. P. Spornraft-Ragaller
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P. Spornraft-Ragaller und D. Varwig-Janßen geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Spornraft-Ragaller, P., Varwig-Janßen, D. Sexuell übertragbare Infektionen und männliche Fertilität. Hautarzt 69, 1006–1013 (2018). https://doi.org/10.1007/s00105-018-4300-9

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