The main cause of inflammatory disease in the male genital tract are sexually transmitted pathogens or uropathogens (such as Chlamydia trachomatis or Escherichia coli). Furthermore, the spread of viral infections through the bloodstream needs to be considered. The diagnostic evaluation of urogenital infections in most patients with infertility is hampered by an asymptomatic primary chronic disease course. Non-invasive diagnostic markers are currently not available. Especially collecting data on asymptomatic inflammatory reactions in the epididymis and testes is difficult; the latter can be diagnosed with any degree of certainty only by using testicular biopsy. Asymptomatic inflammatory reactions are found in 25% of men who undergo testicular biopsy for infertility.
The current evidence from studies does not allow any definite conclusions about the effects of chronic prostatitis on fertility. However, it was found that after acute inflammation/infection of the epididymis, in 10% of cases no sperm was found in the ejaculate in the long term, and in 30% the number of spermatozoa were reduced; in 60% of men affected by an inflammation/infection of the epididymis, the testes were affected too. In such cases, testicular atrophy with permanent loss of spermatogenesis is a much feared complication.
If pathogens are detected in the male genital tract, eradicating antibiotic therapy is indicated. However, this is no guarantee that the quality of sperm will not be permanently affected or that the outcome will not be infertility. It is possible that such infections trigger permanent immunopathological processes in the genital tract.