Epidemiological and pathogen characteristics of symptomatic male reproductive tract infections in Hunan province: retrospective study

Male reproductive tract infections (MRTIs) are associated with serious clinical complications; however, their epidemiological characteristics remain insufficiently defined due to limitations in conventional diagnostic methods. This study utilized targeted next-generation sequencing (tNGS) to characterize the pathogen spectrum of MRTIs I n Hunan Province, China. Urethral swab specimens were collected from 594 male patients between February 2024 and January 2025. A tNGS panel targeting 61 pathogens was applied for pathogen detection. Statistical analyses were conducted using SPSS version 25.0. Of the 594 male reproductive tract swab samples analyzed, 484 (81.5%) were positive for at least one pathogen. Among the reported positive male samples, the highest positivity rate was observed in the 15–19-year age group (92.7%), followed by a gradual decline with age and a subsequent increase to 59.8% in individuals aged 40–49 years. The most prevalent bacterial pathogens were Ureaplasma parvum (29.5%), Ureaplasma urealyticum (23.3%), and Streptococcus agalactiae (23.3%). Subtype analysis of Ureaplasma parvum identified Ureaplasma parvum serovar 6 as the predominant subtype (11.4%), whereas Ureaplasma parvum serovar 14 was the least prevalent (0.6%). Other frequently detected pathogens included Candida albicans (7.2%) and Herpes simplex virus type 2 (3.3%). Among sexually transmitted pathogens, positivity rates were 5.2% for Neisseria gonorrhoeae and 0.8% for Treponema pallidum . High-risk Human papillomavirus infections were mainly attributable to Human papillomavirus 52 (19.2%) and Human papillomavirus 58 (8.7%). Co-infections were identified in 329 cases (68.0%), most commonly involving Streptococcus agalactiae (29.5%), Ureaplasma urealyticum (27.1%), Mycoplasma hominis (15.8%), and Human papillomavirus 52 (24.9%) or Human papillomavirus 58 (12.5%). Among HPV52-positive cases ( n = 82), multi-subtype HPV co-infections most frequently involved HPV58 (25.6%), Human papillomavirus 53 (17.1%), and Human papillomavirus 51 (11.0%). In addition, bacterial co-infections in Human papillomavirus 53-positive samples were commonly associated with Ureaplasma urealyticum (23.2%), Streptococcus agalactiae (17.1%), and Ureaplasma parvum serovar 6 (12.2%). The tNGS-based analysis demonstrates a high burden of Human papillomavirus and Ureaplasma infections among men in Hunan Province, accompanied by complex co-infection patterns. The observed age-specific distribution of pathogens underscores the need for tailored prevention and control strategies.