Chlamy­dia en­dan­ger­ing men’s fer­til­ity

The Weekend Australian - Travel - - Health - Adam Cress­well

CHLAMY­DIA, the sex­u­ally trans­mit­ted in­fec­tion spread­ing rapidly among the young, may at­tack the fer­til­ity of men as well as women. New re­search sug­gests that far from con­fin­ing its dam­ag­ing ef­fects to women, as pre­vi­ously thought, the bac­te­rial in­fec­tion can dam­age the DNA of men’s sperm — greatly re­duc­ing their chances of father­ing a child as a re­sult.

The find­ings, pre­sented at a con­fer­ence in Wash­ing­ton this week by Span­ish and Mex­i­can re­searchers, have been greeted with con­cern by re­pro­duc­tive health ex­perts in Aus­tralia, where rates of the largely symp­tom­less in­fec­tion are soar­ing among the un­der-30s. Only last week a new re­port showed 47,030 no­ti­fied cases of chlamy­dia in 2006, a nearly 14 per cent in­crease on the pre­vi­ous year and a near-dou­bling on the 24,437 cases re­ported in 2002.

Women make up the bulk of cases — 27,940 of last year’s 47,030, ac­cord­ing to last week’s an­nual sur­veil­lance re­port is­sued by the Na­tional Cen­tre in HIV Epi­demi­ol­ogy and Clin­i­cal Re­search.

How­ever, even th­ese ris­ing rates are thought to be a con­sid­er­able un­der­es­ti­mate, be­cause the lack of symp­toms means chlamy­dia is rarely taken as se­ri­ously as other more ob­vi­ous sex­u­ally trans­mit­ted in­fec­tions, and many cases are never picked up.

In women chlamy­dia can travel to the fal­lop­ian tubes, caus­ing a chronic, low-grade in­flam­ma­tion that even­tu­ally causes scar tis­sue to form, block­ing the tube ir­re­versibly and pre­vent­ing eggs from trav­el­ling to the uterus. Al­though the per­cent­age of cases in which this hap­pens is be­lieved to be small, the fact that many tens of thou­sands of women are in­fected means the cases of in­fer­til­ity will also be con­sid­er­able.

In the latest study, re­searchers led by Jose Luis Fer­nan­dez of the Juan Canalejo Univer­sity Hospi­tal in La Coruna, Mex­ico, ex­am­ined sperm taken from 193 men seek­ing fer­til­ity treat­ment with their part­ners.

Of th­ese, 143 were found to be in­fected with both chlamy­dia and my­coplasma, an­other com­mon sex­u­ally trans­mit­ted bac­terium, while 50 were un­in­fected. In the in­fected group, 35 per cent of the men had sperm with DNA dam­age, a pro­por­tion 3.2 times higher than in the healthy con­trols.

In the in­fected group, both part­ners were then treated with an­tibi­otics. Dur­ing the early stages of treat­ment just 12.5 per cent of the cou­ples con­ceived but, when ther­apy was com­plete, 85.7 per cent had achieved a preg­nancy.

Fer­nan­dez cau­tioned that his study in­volved only ‘‘ a small num­ber of cou­ples, so the re­sults are only pre­lim­i­nary’’.

Basil Dono­van, pro­fes­sor of sex­ual health at the Na­tional Cen­tre in HIV Epi­demi­ol­ogy and Clin­i­cal Re­search, at the Univer­sity of NSW, says if con­firmed by other stud­ies the find­ings would ‘‘ be very ex­cit­ing — it would change the whole ball game’’.

‘‘ At the mo­ment in chlamy­dia con­trol, men are the big blind spot.’’

But if the re­sults are re­peated in fur­ther stud­ies, he says the ‘‘ whole world should start think­ing about screen­ing men’’ for chlamy­dia in­fec­tion. Cur­rently this only tends to hap­pen if a cou­ple presents to an IVF clinic seek­ing help to have a baby.

As­so­ci­ate pro­fes­sor Sarah Robert­son, an NHMRC se­nior re­search fel­low at the Re­search Cen­tre for Re­pro­duc­tive Health at the Univer­sity of Ade­laide, says the find­ings are con­sis­tent with an emerg­ing ev­i­dence that shows sex­u­ally trans­mit­ted in­fec­tions gen­er­ally can dam­age fer­til­ity in men.

Al­lan Pacey, se­nior lec­turer in an­drol­ogy at the Univer­sity of Sh­effield and sec­re­tary of the Bri­tish Fer­til­ity So­ci­ety, says that the emerg­ing un­der­stand­ing of how chlamy­dia af­fects male fer­til­ity should change the way that so­ci­ety ap­proaches the con­di­tion.

‘‘ The mes­sage is that we might think of chlamy­dia as a dis­ease that dam­ages fe­male fer­til­ity, but we need to think again,’’ he said. ‘‘ It does dam­age fe­male fer­til­ity, but it ap­pears to dam­age male fer­til­ity, too.

‘‘ Pre­vi­ously, it was thought that the most wor­ry­ing thing about chlamy­dia in­fec­tions in men was as a con­duit for the in­fec­tion of women. The thing that drives most men to sex­ual health clin­ics is symp­toms, and chlamy­dia is of­ten symp­tom-free.

‘‘ Chlamy­dia is get­ting out of con­trol. We have got to en­cour­age men as well as women to go for screen­ing.’’ Ad­di­tional re­port­ing: The Times

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