The Plausibility of Helicobacter Pylori and CagA Strains Related Infertility Among Males in Alexandria, Egypt

Background: Helicobacter pylori (H. pylori), especially the strains expressing cytotoxin-associated gene A (CagA), besides causing gastric diseases, may also involve other systems including the reproductive system leading to infertility. In males, antibodies produced against H. pylori flagella may cross react with spermatozoa flagella; due to antigenic mimicry between them. Infected males have decreased sperm count, motility and viability, reduced numbers of normally shaped sperms and augmented systemic levels of inflammatory cytokines. Objective(s): to detect H. pylori–related infertility prevalence among males; and to address the possibility that such infection may play a detrimental role in their semen quality. Methods: One hundred infertile male patients attending a private hospital in Alexandria were screened for H. pylori by enzyme linked immunosorbent assay (ELISA). CagA strains were further identified using CagA IgG ELISA. Semen analysis was performed to assess semen quality as regards sperm count, motility, vitality and morphology. Results: H. pylori seropositivity was 73% (73 out of 100) among screened cases. Sixty out of the 73 positive cases for H. pylori IgG (82.19%) were CagA strains. H. pylori prevalence was significantly higher among the group of patients with idiopathic infertility (79.7%) than among those who had one or more diagnosed causes of infertility; p value= 0.024. CagA status significantly influenced the quality of semen among infected cases compared to uninfected ones. (p value<0.001). Conclusion: H. pylori infection; specially by CagA strains can be responsible for cases of idiopathic infertility in males through its negative effect on semen quality.