A nonobstructive azoospermic patient with Trichomonas vaginalis infection in testes

Dear Editor, Trichomonas vaginalis (T. vaginalis), a flagellated protozoan parasite emerged as one of the most common nonviral sexually transmitted infections worldwide, often inhabits the vagina, urethra, prostate, and epididymis.1 It has been estimated that there are more than 170 million new cases of T. vaginalis infections per year worldwide. However, current knowledge of T. vaginalis and trichomoniasis is based mainly on studies in female vaginal infections. The prevalence of trichomoniasis in males is far less well characterized than that in females, probably because the infection seems to be asymptomatic in most men and can be resolved after treatment with one dose of metronidazole.1–3 Among men, trichomoniasis has been considered as a cause of nongonoccocal urethritis (NGU) and as involvement in the impairment of male fertility.1,3 T. vaginalis is found more often in infertile men than that in fertile individuals and its presence in semen results in significant decreased sperm parameter values, such as motility, normal morphology and viability.4 In vitro studies have also shown that T. vaginalis and its secretory products reduce sperm motility and fertilizing capacity.4,5 Although T. vaginalis has been identified in urethral discharge, urine, semen, and prostatic fluid, its infection may occur in other areas of the urogenital system. In rare cases reported, T. vaginalis infects the epididymis and prostate gland and occasionally, the testis.4,6,7 Herein, we report a novel case of nonobstructive azoospermia (NOA) with T. vaginalis infection in the testis. A 32-year-old male patient (1.76 m height and 90 kg weight), married for 10 years, presented with the complaint of infertility. General physical examination was normal and the ultrasound examination demonstrated normal epididymides, vasa deferentia, prostate, seminal vesicles, and ejaculatory duct. The testicular volume of each side was 6 ml, somewhat less than normal. Repeated semen analyses found no spermatozoa in the ejaculate, even after centrifugation. His endocrine profile listed in Table 1 demonstrated that estrogen (E2) was a bit high while testosterone was A nonobstructive azoospermic patient with Trichomonas vaginalis infection in testes