Title:Mixed Sexually Transmitted Infections in Infertile Couples: Empirical Treatment and Influence on Semen Quality
Volume: 16
Issue: 3
Author(s): Mykola Yasynetskyi, Oleg Banyra*, Oleg Nikitin, Iryna Ventskivska, Vadym Kozlov, Mykola Kvach and Andrii Borzhievskyy
Affiliation:
- Department of Urology, St. Paraskeva Medical Centre, Lviv,Ukraine
Keywords:
Mixed sexually transmitted infections, empirical treatment, trichomoniasis, ureaplasmosis, mycoplasmosis, Trichomonas vaginalis, Mycoplasma genitalium.
Abstract:
Background: Trichomonas vaginalis (TV), Mycoplasma genitalium (MG) and Ureaplasma
urealyticum (UU) are common sexually transmitted infections (STIs) that are diagnosed in infertile
couples (cps). In cases with their simultaneous presence in a patient (mixed STI, MSTIs),
treatment is complicated by the different sensitivity of microorganisms to antibacterial drugs. Moreover,
in cases of complicated infections, the empirical treatment should be started before obtaining
the results of drug susceptibilities.
Objective: The objective of the current study is to find the effective and well-tolerated combination
of drugs for the empirical antibacterial treatment of mixed STIs presented by TV, MG and UU in
infertile couples. We also aimed to establish the influence of mixed STIs on semen quality.
Methods: Our prospective study included 154 infertile couples (308 patients) with confirmed symptomatic
MSTIs in one of the couples caused by the simultaneous presence of TV, MG and UU. All
couples were randomized on three groups for empirical treatment: Group 1 (n=49 cps, 98 pts) who
were treated by initial prescribing of anti-trichomoniasis drug Secnidazole, 2.0 g po followed by
Azythromycin 500 mg on day 1 continuing by 250 mg on days 2-7; Group 2 (n=52 cps, 104 pts:
Secnidazole, 2.0 g po followed by Josamycin 1000 mg bid for 12 days); Group 3 (n=53 cps, 106
pts: Secnidazole, 2.0 g po followed by Moxifloxacin 400 mg once daily for 12 days). The endpoints
were clinical and microbiological cure rates as well as the frequency of side-effects in analyzed
groups. We determined the basic parameters of the spermogram and Deoxyribonucleic acid
(DNA) fragmentation levels in 59 patients with MSTIs before and at the 3rd, 6th and 9th month after
pathogens eradication comparing them with results in 63 healthy sperm donors.
Results: After the treatment, clinical cure rates in analyzed groups were 82.6% (Group 1) vs.
96.1% (Group 2) vs. 92.3% (Group 3). Microbiological cure rates (UU+MG) were 73.9% vs.
97.1% vs. 84.5% correspondingly (p<0.05). TV microbiological cure rates were 97.8% vs. 98.0%
vs. 96.1% (p>0.05). Side-effects were registered in 28.6% vs. 12.5% vs. 18.9% cases correspondingly
(p<0.05). In MSTIs patients, we registered the increasing DNA fragmentation rates, leucocytes
count and decreasing semen volume, motility, vitality, sperm concentration, total spermatozoa
number and number of spermatozoa with normal morphology. At the 6th month after complete
pathogens eradication, these parameters approached normal values.
Conclusion: At the present time, the combination of Secnidazole+Josamycin can be considered the
most effective and well-tolerated for the empirical treatment in patients with MSTIs presented by
TV, MG and UU. Complete eradication of these MSTIs in males improves their semen parameters.
