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Background: Acquired Immunodeficiency Syndrome was recognized as a sexually transmitted disease early in the Human Immunodeficiency Virus pandemic, but thirty years later, the source of HIV in semen remains unknown. Longitudinal studies of HIV in paired specimens of blood and semen have revealed: 1) HIV burden is highly discordant between blood and semen compartments; 2) HIV-infected cells in semen are generally not the source of HIV particles in seminal plasma, suggesting multiple foci of infection in the male GU tract; 3) viral shedding into semen persists for years in men on successful anti-retroviral therapy with undetectable burden of virus in blood plasma; and 4) HIV in semen is not predicted by the presence of bacteria in semen.
Methods: 52 HIV-infected men seeking to parent by surrogacy underwent a panel of infectious disease tests in blood and urine specimens as mandated by the Food and Drug Administration that were paired within 7 days to semen specimens planned for use in a fertility cycle.
Results: 1) 92% of the men were seropositive for cytomegalovirus (CMV); 2) the incidence of CMV (48%) was four-fold higher than the incidence of HIV (11%) in semen specimens submitted for use in fertility cycles; 3) the presence of CMV in semen did not correlated with elevations in semen leukocytes, age, or poor sperm morphology, but did correlate with CD4+ lymphocyte counts less than 700/ul blood.
Conclusions: For reasons not understood, semen from HIV infected men has a higher incidence of infection with CMV than semen from non-HIV infected men. CMV can infect fetuses and is the leading cause of sensorineural damage in newborns in the U.S. The results suggest that immune suppression may allow CMV shedding into semen. We have previously reported a PCR study of bacteria in 45 semen specimens from a cohort of 34 men not HIV-infected. Fifty-six percent of the specimens from 22 (65%) of the men tested PCR positive for abundant bacteria (>20,000 organisms/ml of semen). Gram positive anaerobic cocci (Peptoniphilis, Anaerococcus, Peptostreptococcus sp.) were the most abundant organisms, followed by Corynebacteria. Bacteria negative specimens had five-fold higher semen lymphocytes and more normal forms than bacteria positive specimens, suggesting that patients with even subtle degrees of immune compromise have a higher risk of bacterial and viral infection in semen, with potential compromise of fertility.
Taken together, these studies suggest that full characterization of pathogens in semen may reflect clinically important parameters of overall male health.