Dear Editor,
We read with great interest the article by Priam et al.1 The study provides valuable insights into the association between human papillomavirus (HPV) semen carriage and male infertility, highlighting a prevalence of 22.3% HPV-positive semen samples among infertile men, with high-oncogenic-risk genotypes predominating (57.6%). The findings underscore a significant correlation between HPV carriage and abnormal sperm parameters, including oligozoospermia, asthenozoospermia, and teratozoospermia (adjusted odds ratio [OR]: 4.1, P < 0.001).
The study’s strengths are noteworthy, particularly its prospective design, large cohort (n = 461), and rigorous multivariate adjustments for confounders. The use of a validated multiplex polymerase chain reaction (PCR) assay for HPV genotyping adds robustness to the virological analysis. However, we wish to highlight several points for further discussion.
Clinical implications: the study advocates for HPV screening in semen as part of male infertility workups. Given the observed association between HPV and poor sperm quality, should HPV testing become routine in andrology clinics? Could antiviral interventions or HPV vaccination (e.g., Gardasil 9, covering 28.6% of detected genotypes) improve fertility outcomes, as suggested by Foresta et al.2
Mechanistic gaps: while the study links HPV to abnormal spermograms, the absence of correlation with DNA fragmentation index (DFI) or sperm decondensation index (SDI) contrasts with a prior report.3 Could this discrepancy reflect methodological differences (e.g., terminal deoxynucleotidyl transferase dUTP nick-end labeling [TUNEL] vs sperm chromatin structure assay [SCSA] for DFI) or the transient nature of HPV sperm binding? Further mechanistic studies are needed.
Limitations: the cross-sectional design precludes causal inference. Longitudinal studies tracking HPV clearance and semen parameter changes would clarify whether HPV is a direct contributor or a bystander in infertility. Additionally, the lack of data on female partners’ HPV status limits understanding of couple-level impacts, as highlighted by Depuydt et al.4
Vaccination advocacy: with HPV vaccination rates low in French males (introduced only in 2019), the study strengthens the case for broader male vaccination to mitigate fertility risks. Public health efforts should emphasize this benefit alongside cancer prevention.
In conclusion, Priam et al.1 provide compelling evidence that HPV semen carriage is a potential biomarker for male infertility. Future research should explore therapeutic strategies, such as vaccination or antiviral therapy, and investigate HPV’s role in idiopathic infertility. We commend the authors for this timely contribution and encourage further studies to translate these findings into clinical practice.
COMPETING INTERESTS
Both authors declare no competing interests.
REFERENCES
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