Impact of Bacteria on Semen Parameters and Their Antibiotic Susceptibility Pattern in Infertile Men

Background: Infertility, defined as the inability of a sexually active, non-contracepting couple to achieve pregnancy in one year [1], affects over 20% of couples. Male factors contribute to up to 60% of cases, with urogenital tract infections leading to bacteriospermia being a significant etiological agent [2]. These infections impair sperm function through mechanisms like acrosome dysfunction, DNA fragmentation, and inducing oxidative stress, contributing to idiopathic infertility [1, 14]. This study aimed to determine the prevalence of bacterial pathogens in semen, quantify their adverse effects on semen parameters, and analyze their antibiotic susceptibility patterns to optimize clinical treatment. Methods: This was an observational study conducted on 249 positive semen cultures evaluated following the WHO 5th Edition guidelines [12]. Bacterial pathogens were isolated and identified using standard culture methods. Antibiotic susceptibility testing (AST) was performed using the Kirby-Bauer disk diffusion method. Data were analyzed using ONE-way ANOVA and the Tukey test (p<0.05). Results: A total of 249 bacterial isolates were analyzed. The most frequent isolates were Klebsiella (35.7%) , followed by Enterococcus (26.5%) , and Staphylococcus (14.1%) . Bacteriospermia was significantly associated with abnormal semen profiles, including oligoasthenoteratozoospermia (OATS) , showing a statistically significant difference in sperm concentration, total motility, progressive motility, vitality, and normal forms compared to normozoospermia (p<0.05). Klebsiella isolates showed high resistance to Ampicillin (41.0%) and Cefuroxime (38.0%) . Conversely, high sensitivity was observed for Nitrofurantoin (36.7%) , Gentamicin (35.2%) , and Amikacin (34.5%) against Klebsiella isolates. Conclusion: Bacteriospermia presents a major challenge in male infertility management. The high prevalence of drug-resistant isolates, particularly Klebsiella , underscores the critical necessity of targeted, culture-guided therapy using sensitive agents like Gentamicin or Nitrofurantoin to improve fertility outcomes.