Are antisperm antibodies really associated with proven chronic inflammatory and infectious diseases of the male reproductive tract?

Background: It is debated whether chronic urogenital inflammations and infections may trigger the formation of antisperm antibodies (ASA) in semen.

Objective: To evaluate the formation of ASA in defined chronic inflammatory and infectious diseases of the male reproductive tract (MRT).

Design, Setting, And Participants: Three hundred sixty-five patients retrospectively enrolled in a single center were categorized as having National Institutes of Health (NIH) category II chronic prostatitis (n=38), NIH category IIIa chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) (n=59), NIH category IIIb CP/CPPS (n=213), chronic epididymitis (n=34), and chronic urethritis (n=21). Forty-five age-matched men served as controls.

Measurements: All subjects underwent microbiologic and cytologic analysis for common bacteria, yeasts, and mycoplasma using the four-glass test. Urine samples, ejaculates, and urethral swabs were analyzed with polymerase chain reaction (PCR) for Chlamydia trachomatis and Neisseria gonorrhea. Semen analysis followed World Health Organization (WHO) standards. ASA in seminal plasma were analyzed using the mixed agglutination reaction (MAR) test.

Results And Limitations: The overall positive detection rate of clinically significant levels (> or = 50% of spermatozoa coated by ASA) of IgG and IgA antibodies was 1.8% and 0.8%, respectively, in the patient group. No clinically significant levels of ASA were detected in the control group, and no statistically significant difference was observed between controls and patients (IgG, p=1.0; IgA, p=1.0). No difference was found between the different inflammatory and infectious diseases and the control group in the detection rate of ASA, even when the cut-point value was lowered to > or = 1% (IgG, p=0.4; IgA, p=0.3). Moreover, in one selected subgroup of patients (n=26) with persistent increased inflammatory parameters (peroxidase-positive leukocytes [PPL] > or = 1 x 10(6)/ml and elastase > or = 230 ng/ml), no significant difference in the levels of ASA was observed compared with the controls (IgG, p=0.1; IgA, p=0.8).

Conclusion: There is no association between chronic inflammatory or infectious diseases of the MRT and the presence of ASA in semen.