Rising Chlamydia Rates Among Reproductive-Age Men in a High-Burden State: Implications for Male Factor Infertility

Objective: To evaluate trends in sexually transmitted infections among reproductive-age men in a high-burden region and assess implications for male reproductive health. Design: Retrospective population-based trend analysis. Materials and Methods: State-level surveillance data were obtained from the Centers for Disease Control and Prevention (CDC) WONDER database. Rates of chlamydia and gonorrhea among males aged 20–24 and 25–29 years in Mississippi were analyzed. Mississippi was selected due to its high STI burden relative to national averages. Annual rates per 100,000 population were evaluated over time using linear regression. Outcomes included temporal trends in infection rates, with statistical significance defined as p<0.05. Results: Chlamydia rates increased significantly among males aged 20–24 (slope +55.3 cases per 100,000/year, p<0.001, R²=0.97) and 25–29 (slope +35.7, p<0.001, R²=0.99), corresponding to >250–350% increases over the study period. Gonorrhea trends differed by age group, with a decrease among males aged 20–24 (slope −11.0, p<0.001, R²=0.70) and no significant change among males aged 25–29 (p=0.06). Conclusions: Chlamydia rates are rising significantly among men at peak reproductive age in a high-burden state. Given the association between chlamydial infection and epididymitis leading to obstructive azoospermia, these findings suggest a growing and underrecognized contributor to male factor infertility. Targeted prevention and fertility-focused counseling may be warranted.