Chronic epididymitis: impact on semen parameters and therapeutic options

Abstract

Chronic inflammatory conditions of the genital tract are frequently encountered in male fertility problems. The diagnosis, however, is hampered by a mostly asymptomatic course of the disease as well as inappropriate definitions and unspecific diagnostic criteria. With regard to their impact on male reproductive function, epididymitis seems to be more relevant than inflammation/infection of the prostate and/or seminal vesicles. Chronic epididymitis may result in reduced sperm count and motility. Impaired sperm motility because of epididymal dysfunction is frequently associated with an atypical staining behaviour of sperm tails. In many cases of chronic epididymitis, the number of leukocytes in the ejaculate is below the threshold of 10(6) per ml; therefore, consideration of additional markers of inflammation such as granulocyte elastase, pro-inflammatory cytokines (e.g. interleukin-6 or 8) or reactive oxygen species is helpful for establishing the diagnosis. Besides changes in the conventional sperm parameters, alterations in DNA integrity have been observed. Positive effects of antiphlogistic/antibiotic treatment on semen quality have been reported; however, controlled prospective studies are still lacking.

Pattern Recognition Receptor–Initiated Innate Antiviral Responses in Mouse Epididymal Epithelial Cells

“…Viral infections in the epididymis may perturb fertility and spread sexually transmitted pathogens (4,(32)(33)(34). The mechanisms underlying the innate antiviral responses in the epididymis merit clarification.…”

Association analysis identifies new risk loci for non-obstructive azoospermia in Chinese men

“…The lead SNP is 34 kb upstream of interleukin (IL)-17A and 84 kb downstream of IL-17F. Studies have proven that testicular inflammatory disorders leading to impairment of spermatogenesis are the primary reasons for male infertility, and T helper cells play an essential role in this condition [17][18][19] . T helper 17 cells have been identified as a distinct lineage of CD4 þ T cells and are characterized by the production of IL-17A, IL-17F and many other cytokines 20,21 .…”

Testosterone Replacement Effectively Inhibits the Development of Experimental Autoimmune Orchitis in Rats: Evidence for a Direct Role of Testosterone on Regulatory T Cell Expansion

“…In most cases, inflammation involves also the epididymis, resulting in a combined epididymo-orchitis (4). Whereas acute testicular inflammation is symptomatic and mainly related to infection, the subacute, or chronic, form of the disease is predominately asymptomatic (4)(5)(6). It should be noted that although the acute phase of the disease, which is the consequence of infection, can be successfully treated with antibiotics and antiphlogistics, the inflammatory reaction is more insidious in that it can continue undetected in both testes slowly undermining testicular function (4,(7)(8)(9)(10).…”