P-453 Bacterial semen infections of North-African men: A 10-year retrospective study of 10.386 semen samples between January, 2013 and December, 2022
Authors: Benkhalifa M , Zidi W , Fourati K , Bahri H 
Published: June 2023

Abstract

Study question
What is the situation of bacterial semen infections in North African men between 2013 and 2022?

Summary answer
The proportion of positive-bacterial-semen-cultures of North-Afrian men was of 5.9%: Tunisian-patients positive rate was of 5.8%. Algerians of 7.9% and of Lybian was of 4.7%.

What is known already
Numerous bacteria can influence spermatogenesis process at different levels and disrupt spermatozoa development, maturation, and transport. Presence of pathogenic bacteria in the male-genital-system has been mainly associated with poor sperm function, leading to infertility. Bacterial semen infections such as infections by Chlamydia-trachomatis (CT), Mycoplasma-hominis (MH) and genitalium (MG), Ureaplasma urealyticum (UU) and parvum (UP), Escherichia coli (EC), Enterococcus-faecalis (EF), Staphylococcus aureus (SA) and haemolyticus (SH), Helicobacter pylori, Streptococcus agalactiae, Gardnerella-vaginalis, Anaerococcus, Neisseria gonorrhoeae (NG), and Pseudomonas aeruginosa are among the most common isolated bacteria, affecting semen quality and interfering with male fertility. (Wang et al., 2021; Farsimadan and Motamedifar, 2020).

Study design, size, duration
Retrospective study including 10.386 Sperm-culture-analyzes performed between January, 2013-December, 2022 of patients from North-Africa (Tunisians, Algerians and Libyans) aged between 19 and 73 years-old (y.o) (average-age: 43.2 y.o ± 7.16). Semen samples were divided in two main groups, Group-1: Bacterial-Semen-Infected-samples and Group-2: Semen without bacterial-infection. The investigation of the situation of North-African men’ semen-bacterial-infections was based on the types of bacteria analyzed, the years from 2013 to 2022 (year by year) and the nationalities of the patients.

Participants/materials, setting, methods
10.386 North-African-patients composed of 79% of Tunisian-patients (n = 8201), 11% of Algerian-patients (n = 1142) and 10% of Libyan-patients(n = 1038) presented to the Laboratory for Semen-infection-diagnosis. Semen-samples were analyzed according to World-Health-Organization(WHO)-guidelines. Real-time-polymerase-chain-reaction (RT-PCR) and biochemical-identification using Vitek2®ID-cards (BioMérieux) were used for bacterial-semen-infections’ detection such as with atypical-bacteria, aerobic/anaerobic bacteria. Statistical-analyzes were performed using SPSS22.0 for Windows-software. Kolmogorov–Smirnov-test for normality-analysis and comparisons by Student-t-test/Mann–Whitney-U-test, as appropriate. Pearson/Spearman’ tests for correlations were used as appropriate, P-value &lt;0.05 was considered as significant.

Main results and the role of chance
A total of 10.386 semen cultures were performed with 613 positive-bacterial-semen-cultures, showing an annual variation rate of 0.7% from the first year to the last year of the study. The proportion of positive bacterial semen cultures was of 5.9% and was stable throughout the study period (4.8% to 7.3%) in except of 2018 (9.5%) and 2022 (12.5%). Leucocytes concentration which is positively correlated to bacterial-semen-infections in our study (r = 0.165; p &lt; 0.001) have shown a significant increase in its average levels between 2019 and 2021 in comparison with the other years of the study. UU was the most present atypical bacteria in Goup-1 with 270 infected-samples, UP was the second with 134 infected-samples and then MH with 71 infected-samples and CT with 19 infected-samples and MG with 13 infected-samples. For aerobic and anaerobic bacteria in Group-1, EC was present with 17.3%, EF with 10.5%, SH with 5.7%, SA with 5.2% and NG with 2.2%. Positive semen cultures of Tunisian patients in our study presented a rate of 5.8%. Algerian positive bacterial semen cultures’ rate was of 7.9% and of Lybian patients was of 4.7%. Our study may represent an update on bacterial-semen-infections of North-African men over the past decade.

Limitations, reasons for caution
Our study is a retrospective-statistical-survey that included patients presenting to the laboratory for bacterial-semen-infection-diagnosis due to a pathology and/or inflammation of the genital tract or for a simple fertility-diagnosis. Meta-analysis studies in addition to more prospective-randomized-controlled-trials in collaboration with other Microbiology/Andrology laboratories are necessary to confirm or deny our results.

Wider implications of the findings
These results should interest epidemiologists, reproductive biology fundamentalists, urologists, microbiologists, gynecologists, and embryologists who want to improve the investigations on the semen bacterial infections in North-African men with or without fertility problems.

Trial registration number
Not applicable