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Infektionen in der Reproduktionsmedizin

Infectious diseases in reproductive medicine

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Der Gynäkologe Aims and scope

Zusammenfassung

Infektionen spielen im Zusammenhang mit der Reproduktionsmedizin in vielerlei Hinsicht eine bedeutsame Rolle:

  • Infektionen können als Ursache für Infertilität/Sterilität beim Mann bzw. der Frau verantwortlich sein,

  • reproduktionsmedizinische Maßnahmen gehören zu den „invasiven Behandlungsmaßnahmen“ und haben per se ein Risiko zur Übertragung/Manifestation von Infektionen,

  • falls es durch Anwendung reproduktionsmedizinischer Maßnahmen zum Eintritt einer Schwangerschaft kommt, so müssen potenzielle Infektionsrisiken für das aus dieser Behandlung hervorgehende Kind beachtet werden.

  • In den Richtlinien zur Durchführung assistierter reproduktionsmedizinischer Maßnahmen wird vor Behandlungsbeginn der Ausschluss/Nachweis bestimmter Infektionskrankheiten gefordert und damit impliziert, dass infizierte Patient(inn)en von den Behandlungsmaßnahmen prinzipiell auszuschließen sind.

In dem vorliegenden Beitrag wird ausführlich auf die o. g. Aspekte eingegangen und es wird aufgezeigt, dass es sich bei vielen der denkbaren Infektionsrisiken eher um theoretische, als um klinisch relevante Probleme handelt. Dem Leser wird damit eine Entscheidungshilfe bei differenzialdiagnostischen und -therapeutischen Fragen zu den Infektionen in der Reproduktionsmedizin vermittelt.

Abstract

Infectious diseases play an important role in human reproduction:

  • they can cause male/female infertility/sterility,

  • ART (assisted reproductive therapy) can facilitate/induce infectious diseases,

  • infectious diseases can complicate a pregnancy arising from ART,

  • official guidelines for ART postulate that before treatment certain infectious diseases such as hepatitis and/or HIV should be excluded in both partners.

This article addresses the above mentioned issues and highlights that some of the potential infectious risk factors are rather theoretical risks than real problems.

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Literatur

  1. Anagrius C, Lore B (2002) Chlamydia-like symptoms can have another etiology. Mycoplasma genitalium—an important and common sexually transmitted disease. Lakartidningen 99: 4854–4859

    PubMed  Google Scholar 

  2. Anderson DJ, Politch JA (1996) In: Centola G, Ginsburg KA (eds) Evaluation and treatment of the infertile male. Cambridge University Press, Cambridge: 263–277

  3. Balmelli T, Stamm J, Dolina-Giudici M et al. (1994) Bacteroides ureolyticus in men consulting for infertility. Andrologia 26: 35–38

    CAS  PubMed  Google Scholar 

  4. Brady MT, Reiner CB, Singley C, Roberts WH, Sneddon JM (1988) Unexpected death in an infant with AIDS: disseminated cytomegalovirus infection with pancarditis. Pediatr Pathol 8: 205–214

    CAS  PubMed  Google Scholar 

  5. Brook I (2002) Microbiology and management of polymicrobial female genital tract infections in adolescents. J Pediatr Adolesc Gynecol 15: 217–226

    Article  PubMed  Google Scholar 

  6. Bundesärztekammer (1998) Richtlinien zur Durchführung der assistierten Reproduktion. Dtsch Ärztebl 9: B2454–B2459

    Google Scholar 

  7. Carlsen E, Giwercman A, Keiding N, Skakkebaek NE (1992) Evidence for deceasing quality of semen during past 50 years. BMJ 305: 19–22

    Google Scholar 

  8. Cesur S, Ciftci A, Sozen TH, Tekeli E (2003) A case of epididymo-orchitis and paravertebral abscess due to brucellosis. J Infect 46: 251–253

    Article  CAS  PubMed  Google Scholar 

  9. Chen F, Brook G, Williams G, Murphy S (2004) Tuberculous epididymo-orchitis presenting within the setting of a sexually transmitted disease clinic. Sex Transm Dis 31: 163–165

    PubMed  Google Scholar 

  10. Clad A (2002) Chlamydia and other sexually transmitted bacterial infections. Ther Umsch 59: 459–463

    CAS  PubMed  Google Scholar 

  11. Clad A, Freidank H, Plunnecke J, Jung B, Petersen EE (1994) Chlamydia trachomatis species specific serology: ImmunoComb Chlamydia bivalent versus microimmunofluorescence (MIF). Infection 22: 165–173

    CAS  PubMed  Google Scholar 

  12. Clad A, Prillwitz J, Hintz KC, Mendel R, Flecken U, Schulte-Monting J, Petersen EE (2001) Discordant prevalence of chlamydia trachomatis in asymptomatic couples screened using urine ligase chain reaction. Eur J Clin Microbiol Infect Dis 20: 324–328

    Article  CAS  PubMed  Google Scholar 

  13. Cohen CR, Gravelle L, Symekher S, Waiyaki P, Stamm WE, Kiehlbauch JA (2003) Etiology of persistent tubo-ovarian abscess in Nairobi, Kenya. Infect Dis Obstet Gynecol 11: 45–51

    PubMed  Google Scholar 

  14. Cottell E, Lennon B, McMorrow J et al. (1997) Processing of semen in an antibiotic-rich culture medium to minimize microbial presence during in vitro fertilization. Fertil Steril 67: 98–103

    Article  CAS  PubMed  Google Scholar 

  15. De Geyter C, De Geyter M, Behre HM, Schneider HP, Nieschlag E (1994) Peroxidase-positive round cells and microorganisms in human semen together with antibiotic treatment adversely influence the outcome of in-vitro fertilization and embryo transfer. Int J Androl 17: 127–134

    PubMed  Google Scholar 

  16. Eggert-Kruse W, Probst S, Rohr G et al. (1995) Screening for subclinical inflammation in ejaculates. Fertil Steril 64: 1012–1022

    CAS  PubMed  Google Scholar 

  17. Engel NS, Bollmann R, Gantenberg R (1994) Das Vorkommen von Ureaplasmen, Chlamydien und anderen Bakterien im Ejakulat von Männern aus ungewollt kinderlosen Partnerschaften. Fertilität 10: 31–35

  18. European Association of Urology (2001) Guidelines on infertility. Arnhem, Niederlande, pp 44–47

  19. Familiari U, Larocca LM, Tamburrini E, Antinori A, Ortona L, Capelli A (1991) Premenopausal cytomegalovirus oophoritis in a patient with AIDS. AIDS 5: 458–459

    CAS  PubMed  Google Scholar 

  20. Furuya R, Takahashi S, Furuya S, Kunishima Y, Takeyama K, Tsukamoto T (2004) Is seminal vesiculitis a discrete disease entity? Clinical and microbiological study of seminal vesiculitis in patients with acute epididymitis. J Urol 171: 1550–1553

    PubMed  Google Scholar 

  21. Gembruch U, Diedrich K, Al-Hasani S et al. (1988) Die transvaginale sonographisch gesteuerte Follikelpunktion. Geburtsh Frauenheilk 48: 617–624

    CAS  PubMed  Google Scholar 

  22. Hoosen AA, O’Farrell N, van den EJ (1993) Microbiology of acute epididymitis in a developing community. Genitourin Med 69: 361–363

    CAS  PubMed  Google Scholar 

  23. Horn LC, Bilek K (1993) Genital actinomycosis in the women with in situ intrauterine device. Pathologe 14: 101–104

    CAS  PubMed  Google Scholar 

  24. Hosseinzadeh S, Brewis IA, Eley A et al. (2001) Co-incubation of human spermatozoa with Chlamydia trachomatis serovar E causes premature sperm death. Hum Reprod 16: 292–299

    Article  Google Scholar 

  25. Iwasaki M, Nishikawa A, Akutagawa N, Fujimoto T, Teramoto M, Kudo R (2003) A case of ovarian actinomycosis. Infect Dis Obstet Gynecol 11: 171–173

    PubMed  Google Scholar 

  26. Jalal H, Bahadur G, Knowles W, Jin L, Brink N (2004) Mumps epididymo-orchitis with prolonged detection of virus in semen and the development of anti-sperm antibodies. J Med Virol 73: 147–150

    Article  CAS  PubMed  Google Scholar 

  27. Jarow JP, Kirkland JA, Assismos DG (1992) Association of antisperm antibodies with chronic nonbacterial prostatitis. Urology 36: 154–156

    Google Scholar 

  28. Keck C, Gerber-Schäfer C, Clad A, Wilhelm C, Breckwoldt M (1998) Seminal tract infections: Impact on male fertility and treatment options. Hum Reprod Update 4: 891–903

    Article  CAS  PubMed  Google Scholar 

  29. Keck C, Grützmacher E, Neulen J, Breckwoldt M (1998) Antibiotische Behandlung der asymptomatischen Leukozytospermie vor In-vitro-Fertilisation: Ergebnisse einer prospektiven kontrollierten Studie. Geburtsh Frauenheilk 58: 310–314

    Google Scholar 

  30. Keck C (2002) Diagnostik und Therapie des unerfüllten Kinderwunsches. Uni-Med, Bremen

  31. Kohn FM, Erdmann I, Oeda T et al (1998) Influence of urogenital infections on sperm functions. Andrologia 30 (Suppl 1): 73–80

    PubMed  Google Scholar 

  32. Leruez-Ville M, Kunstman JM, De Almeida M et al. (2000) Detection of hepatitis C virus in the semen of infected men. Lancet 356: 42–43

    Article  CAS  PubMed  Google Scholar 

  33. Levy R, Tardy JC, Bourlet T et al. (2000) Transmission risk of hepatitis C virus in assisted reproductive techniques. Hum Reprod 15: 810–816

    Article  CAS  PubMed  Google Scholar 

  34. Liversedge NH, Jenkins JM, Keay SD et al. (1996) Antibiotic treatment based on seminal cultures from asymptomatic male partners in in-vitro fertilization is unnecessary and may be detrimental. Hum Reprod 11: 1227–1231

    CAS  PubMed  Google Scholar 

  35. Mardh PA (2004) Tubal factor infertility, with special regard to chlamydial salpingitis. Curr Opin Infect Dis 17: 49–52

    Article  PubMed  Google Scholar 

  36. Martin-Du Pan R, Bischof P, de Bocard G, Campana A (1997) Is diclofenac helpful in the diagnosis of partial epididymal obstruction? Hum Reprod 12: 396–397

    Article  PubMed  Google Scholar 

  37. McKee TA, Avery S, Majid A et al. (2000) Risks for transmission of hepatitis C virus during artificial insemination. Fertil Steril 66: 161–163

    Google Scholar 

  38. Mendez LE, Bhoola SM, Horowitz IR (1998) Bilateral tubo-ovarian abscesses four years after total abdominal hysterectomy. Infect Dis Obstet Gynecol 6: 138–140

    Article  CAS  PubMed  Google Scholar 

  39. Michelmann HW (1998) Influence of bacteria and leukocytes on the outcome of in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Andrologia 30 (Suppl 1): 99–101

    PubMed  Google Scholar 

  40. Monga M, Roberts JA (1994) Spermaglutination by bacteria: receptor-specific interactions. J Androl 15: 151–156

    CAS  PubMed  Google Scholar 

  41. Morrison JC, Givens JR, Wiser WL, Fish SA (1975) Mumps oophoritis: a cause of premature menopause. Fertil Steril 26: 655–659

    CAS  PubMed  Google Scholar 

  42. Nieto Y, Ross M, Gianani R, Shpall EJ, Cagnoni PJ, Bearman SI, Jones RB (1999) Post-mortem incidental finding of cytomegalovirus oophoritis after an allogeneic stem cell transplant. Bone Marrow Transplant 23: 1323–1324

    Article  CAS  PubMed  Google Scholar 

  43. Ombelet W, Bosmans E, Janssen M (1997) Semen parameters in a fertile versus subfertile population a need for change in the interpretation of semen testing. Hum Reprod 12: 987–993

    Article  CAS  PubMed  Google Scholar 

  44. Paavonen J, Eggert-Kruse W (1999) Chlamydia trachomatis: impact on human reproduction. Hum Reprod Update 5: 433–447

    Article  CAS  PubMed  Google Scholar 

  45. Papatsoris AG, Mpadra FA, Karamouzis MV, Frangides CY (2002) Endemic brucellar epididymo-orchitis: a 10-year experience. Int J Infect Dis 6: 309–313

    Article  PubMed  Google Scholar 

  46. Parr NJ, Prasad BR, Hayhurst V, McMillan A, Leen CS, Fowler JW (1993) Suppurative epididymo-orchitis in young „high risk“ patients—a new problem? Br J Urol 72: 949–951

    CAS  PubMed  Google Scholar 

  47. Peeters MF (1996) Safety aspects. In: Bras M, Lens JW, Piederiet MH et al. (eds) Laboratory aspects of in-vitro fertilization. Organon, Niederlande, pp 271–283

  48. Peters AJ, Hecht B, Durinzi K et al. (1992) Salpingitis or oophoritis: what causes fever following oocyte aspiration and embryo transfer? Obstet Gynecol 81: 876–877

    Google Scholar 

  49. Petersen, EE (2003) Infektionen in Gynäkologie und Geburtshilfe. Thieme, Stuttgart

  50. Politch J, Wolff H, Hill JA, Anderson DJ (1993) Comparison of methods to enumerate white blood cells in semen. Fertil Steril 60: 372–3375

    CAS  PubMed  Google Scholar 

  51. Punnonen R, Kiilholma P, Meurman L (1983) Female genital tuberculosis and consequent infertility. Int J Fertil 28: 235–238

    CAS  PubMed  Google Scholar 

  52. Puolakkainen M, Vesterinen E, Purola E, Saikku P, Paavonen J (1986) Persistence of chlamydial antibodies after pelvic inflammatory disease. J Clin Microbiol 23: 924–928

    CAS  PubMed  Google Scholar 

  53. Purvis K, Christiansen E (1996) The impact of infection on sperm quality. Hum Reprod 11: 31–41

    PubMed  Google Scholar 

  54. Reiser M, Schmiegel WH (1999) Chronische Hepatitis C: Fortschritt durch Kombinationstherapie mit Interferon-alpha and Ribavirin. Dtsch Ärztebl 96: A195–A199

    Google Scholar 

  55. Richens J (2004) Genital manifestations of tropical diseases. Sex Transm Infect 80: 12–17

    Article  CAS  PubMed  Google Scholar 

  56. Robert-Koch-Institut (2000) Richtlinie für Krankenhaushygiene und Infektionsprävention. Urban & Fischer, München

  57. Shalika S, Dugan K, Smith RD et al. (1996) The effect of positive semen bacterial and Ureaplasma cultures on in-vitro fertilization success. Hum Reprod 11: 2789–2792

    CAS  PubMed  Google Scholar 

  58. Sharma TM, Nadasdy T, Leech RW, Kingma DW, Johnson LD, Hanson-Painton O (1994) In situ DNA hybridization study of „primary“ cytomegalovirus (CMV) oophoritis. Acta Obstet Gynecol Scand 73: 429–431

    CAS  PubMed  Google Scholar 

  59. Steyaert SR, Leroux-Roels GG, Dhont M (2000) Infections in IVF: Review and guidelines. Human Reprod Update 6: 432–441

    Article  CAS  Google Scholar 

  60. Stovall DW, Bailey LE, Talbert LM (1993) The role of aerobic and anaerobic semen cultures in asymptomatic couples undergoing in vitro fertilization: effects on fertilization and pregnancy rates. Fertil Steril 59: 197–201

    CAS  PubMed  Google Scholar 

  61. Sullivan KM, Halpin TJ, Kim-Farley R, Marks JS (1985) Mumps disease and its health impact: an outbreak-based report. Pediatrics 76: 533–536

    CAS  PubMed  Google Scholar 

  62. Taparelli F, Squadrini F, De Rienzo B, Lami G, Fornaciari A (1988) Isolation of mumps virus from vaginal secretions in association with oophoritis. J Infect 17: 255–258

    CAS  PubMed  Google Scholar 

  63. Taylor-Robinson D (2002) Mycoplasma genitalium—an up-date. Int J STD AIDS 13: 145–151

    Article  PubMed  Google Scholar 

  64. Tedder RS, Zuckerman MA, Goldstone AH (1995) Hepatitis B transmission from contaminated cryopreservation tank. Lancet 346: 137–140

    Article  CAS  PubMed  Google Scholar 

  65. The American Fertility Society (1992) Guidelines for human embryology laboratories. Fertil Steril 58 (Suppl 1): 1–10

    PubMed  Google Scholar 

  66. Theodoropoulos G, Haarmann W (1995) Abdominal actinomycosis in tubo-ovarian abscess. Zentralbl Gynakol 117: 494–497

    CAS  PubMed  Google Scholar 

  67. Van Os HC, Roozenburg BJ, Jannsen-Caspers HA et al. (1992) Vaginal desinfection with povidon iodine and the outcome of in vitro fertilization. Hum Reprod 7: 349–350

    PubMed  Google Scholar 

  68. Wang S, Jiang P, Peng G (1999) HBV transmission from father to foetus and HBV DNA in tissues outside the liver. Chung Hua Kan Tsang Ping Tsa Chih 7: 203–206

    CAS  PubMed  Google Scholar 

  69. Weidner W, Garbe C, Weissbach L (1990) Initiale Therapie der akuten einseitigen Epididymitis mit Ofloxacin. Urologe 29: 277–280

    CAS  PubMed  Google Scholar 

  70. Weigel M, Beichert M, Melchert F (1999) Assistierte Reproduktion bei HIV-Infektion des Ehepartners—von der Kontraindikation zur Indikation? Reproduktionsmedizin 15: 410–418

    Article  Google Scholar 

  71. Weigel M, Beichert M, Buchholz B (2000) Reproduktionsmedizinische Aspekte chronischer Infektionen mit Hepatitisviren. Reproduktionsmedizin 16: 319–325

    Article  Google Scholar 

  72. Weigel M, Kremer H Sonnenberg-Schwan U (2001) Diagnostik und Behandlung HIV-diskordanter Paare mit Kinderwunsch. Dtsch Ärztebl 98: A2648–A2652

  73. Weigel M, Neumann G, Keck C, Geisthövel F, Rabe T (2002) Empfehlung zu Infektionsrisiken bei Verfahren der assistierten Reproduktion. Frauenarzt 43: 87–94

    Google Scholar 

  74. Westrom LV (1996) Chlamydia and its effect on reproduction. J Br Fer Soc 1: 23–30

    CAS  PubMed  Google Scholar 

  75. Wilson JS, Honey E, Templeton A, Paavonen J, Mardh PA, Stray-Pedersen B (2002) A systematic review of the prevalence of Chlamydia trachomatis among European women. Hum Reprod Update 8: 385–394

    Article  CAS  PubMed  Google Scholar 

  76. World Health Organization (2000) WHO manual for the standardized investigation, diagnosis and management of the infertile male. Cambridge University Press, Cambridge

  77. Yaron Y, Peyser MR Samuel D (1994) Infected endometriotic cysts secondary to oocyte aspiration for in-vitro fertilization. Hum Reprod 9: 1759–1760

    CAS  PubMed  Google Scholar 

  78. Younis JS, Ezra Y, Laufer N et al. (1997) Late manifestation of pelvic abscess following oocyte retrieval for in vitro fertilization in patients with severe endometriosis and ovarian endometriomata. J Assist Reprod Genet 14: 343–346

    CAS  PubMed  Google Scholar 

  79. Zylbergerg H, Thiers V, Lagorce D et al. (1999) Epidemiological and virological analysis of couples infected with hepatitis C virus. Gut 45: 112–116

    PubMed  Google Scholar 

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  1. Universitätsfrauenklinik Freiburg

    C. Keck & A. Clad

  2. Universitätsfrauenklinik, Hugstetter Straße 55, 79106, Freiburg

    C. Keck

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  1. C. Keck
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Correspondence to C. Keck.

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Keck, C., Clad, A. Infektionen in der Reproduktionsmedizin. Gynäkologe 37, 607–620 (2004). https://doi.org/10.1007/s00129-004-1556-1

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