Infections of the Male Genital Tract and Infertility 2521 Initial Nosological Gaps

The state of the art in the field of prostatitis and infertility suffers some gaps originating from classification and definitions given by two parallel research groups ending up with two independent consensus conferences.

The first, originating mainly from the urologic area (NIH Chronic Prostatitis Collaborative Research Network), was inspired by the clinical aspects of prostatitis (difficult to diagnose and to effectively treat) and includes only two categories (II and IV) associated with male infertility [6, 7]. According to the NIH classification, seminal bacterial infection, corresponding to chronic bacterial prostatitis (category II), has a marginal epidemiologic role, since bacterial prostatitis (acute or chronic) accounts for a low number of patients with prostate symptoms (5-10%) [8, 9]. The NIH prostatitis classification recognizes a main role to one gland (prostate) and to two factors: presence of microbial agents and evidence of inflammation (leukocytes) in the semen, expressed prostatic secretion (EPS), or the third voided urine specimen, the so-called VB3.

The second of uroandrologic area was represented by a WHO Task Force on the Diagnosis and Treatment of Infertility [10] and inspired by excretory, posttesticular causes of male infertility. It identifies a diagnostic category affecting male reproductive function and fertility, named male accessory gland infection (MAGI). The presence of MAGI is diagnosed in patients with oligo-, astheno-, and/or teratozoo-spermia (OAT) who fulfill the WHO [10] conventional criteria (Fig. 25.1).

The NIH prostatitis classification is more useful for the diagnosis in presence of prostatitis symptoms, whereas the WHO criteria respond mainly to male infertility

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