Prevalence, Bacterial Profile, and Therapeutic Outcomes of Bacteriospermia in Infertile Men: Impact of Targeted Antibiotics and Antioxidants

Abstract

Introduction: Bacteriospermia is a common but often underdiagnosed contributor to male infertility, capable of impairing semen parameters via inflammation, oxidative stress, and direct sperm damage. Evidence on combined pathogen-specific antibiotic therapy and antioxidant supplementation remains limited, particularly in the Indian context.

Objectives: To determine the prevalence and bacterial spectrum of bacteriospermia among infertile men and to evaluate the effects of targeted antibiotic therapy combined with antioxidants on semen quality.

Methods: This prospective observational study included 160 infertile men aged 21–45 years. Semen analysis and aerobic culture were performed for all participants, classifying them into bacteriospermic and non-bacteriospermic groups. Bacteriospermic men received pathogen-specific antibiotics based on culture sensitivity and a standardized antioxidant regimen for 3 months. Post-treatment semen analysis was compared to baseline. Statistical significance was assessed using paired t-tests and chi-square tests (p < 0.05).

Results: Bacteriospermia was detected in 37.5% of participants, with Enterococcus spp. (32%) and Escherichia coli (28%) being the most common pathogens. Abnormal semen parameters were significantly more prevalent in bacteriospermic men compared to non-bacteriospermic men (50% vs. 30%; OR = 2.1; p < 0.05). E. coli presence correlated with significantly reduced sperm motility (p < 0.01). Post-treatment, 85% of patients achieved negative semen cultures, and significant improvements were observed in sperm concentration, motility, and morphology (p < 0.05).

Conclusions: Bacteriospermia is prevalent among infertile men, even with normal semen parameters, and is associated with impaired semen quality. Routine semen culture, followed by targeted antibiotic and antioxidant therapy, may significantly improve reproductive potential.