Pyospermia

What is pyospermia?

Pyospermia is a condition in which you have an unusually high number of white blood cells in your semen.

Semen is the substance that your penis discharges when you have an orgasm. It contains male reproductive cells (sperm) and fluids made of proteins, vitamins and minerals that provide sperm with energy.

White blood cells (leukocytes) are part of your immune system. They help fight off infections. White blood cells release reactive oxygen species (ROS), which is a powerful substance that destroys organisms that cause infections. However, ROS can also affect healthy tissues, including sperm. ROS:

• Destroys the sperm membrane.
• Impairs sperm movement.
• Damages sperm DNA.

Another name for pyospermia is leukocytospermia (loo-koh-cy-toh-spur-mia).

Is pyospermia serious?

Pyospermia can be serious if you wish to have a biological child. But it depends on its severity. A serious level of pyospermia can affect your ability to have a biological child (fertility). But asymptomatic pyospermia won’t affect your fertility. Asymptomatic pyospermia means you have high levels of white blood cells, but they don’t cause any symptoms.

Is pyospermia normal?

It’s normal to have small amounts of white blood cells in your semen. If you have pyospermia, it means you have high amounts of white blood cells in your semen — more than 1 million white blood cells per 1 milliliter (mL) of semen.

How common is pyospermia?

Less than 5% of men or people assigned male at birth (AMAB) who have a fertility problem have pyospermia.

What are the symptoms of pyospermia?

Many people with pyospermia have no symptoms at all. But an infection is one possible cause of pyospermia. Symptoms of an infection that may cause pyospermia may include:

• Fever.
• Swelling.
• Pain or discomfort when you pee (dysuria).
• Yellow semen.

Why is my sperm yellow and jelly-like?

Semen is usually a white or light gray color. If white blood cells attack your cells, it may turn your semen yellow. Other causes of yellow semen may include:

• Infection.
• Time since your last ejaculation.
• Presence of pee in your semen.

Talk to a healthcare provider if you notice any changes to your semen. They can diagnose the cause and recommend the appropriate treatment.

What causes pyospermia?

Pyospermia causes may include:

• Infection.
• Inflammation in your urethra (urethritis).
• Inflammation in your prostate (prostatitis).
• Autoimmune diseases.
• Narrowing of your urethra (urethral stricture).
• Sexually transmitted infections (STIs), including herpes, gonorrhea and chlamydia.
• Swollen veins in your scrotum (varicoceles).
• An illness that affects your whole body (systemic illness).
• Sexual abstinence (infrequent ejaculation).
• Using tobacco products, marijuana and alcohol.

What kind of infections cause pyospermia?

Infections in the genitourinary system are one potential cause of pyospermia. The genitourinary system includes the organs that make up your reproductive system and urinary system. Common infections include:

• E.coli.
• Mycoplasma.
• Ureaplasma
• Chlamydia.

Is pyospermia contagious?

Pyospermia isn’t contagious. But some of the infections that cause it can be contagious. Get treatment for any infections that cause pyospermia. If an STI causes pyospermia, you and your sexual partners must get treatment. If only one of you gets treatment, you can continue to pass the infection between you.

What are the complications of pyospermia?

Pyospermia may affect your ability to have biological children. The high number of white blood cells in your semen may attack and damage your sperm, which can reduce your sperm’s ability to fertilize an egg (conception).

How is pyospermia diagnosed?

You may get a diagnosis from a healthcare provider who specializes in conditions that affect your urinary tract and reproductive system (urologist) or a provider who specializes in the male reproductive system (andrologist). They may:

• Review your medical history.
• Ask questions about your symptoms and sexual health.
• Conduct a physical examination.

They’ll also order tests to help confirm a pyospermia diagnosis.

What tests will be done to diagnose pyospermia?

A healthcare provider will order a semen analysis. During a semen analysis, a provider will examine a sample of your semen under a microscope. They’ll count the number of white blood cells in your sample and use that number to estimate how many white blood cells would exist in a milliliter of semen. They’ll then order a myeloperoxidase (MPO) stain to diagnose pyospermia. MPO is an enzyme, and its presence indicates pyospermia.

A healthcare provider may also order the following tests to help diagnose the cause of pyospermia:

• Urinalysis (urine test). During a urinalysis, a provider will take a sample of your pee and look for organisms that cause infections within the genitourinary tract.
• Urine flow tests. Urine flow tests measure the speed of your pee (flow rate) when you use the bathroom.
• Imaging tests. A provider may order X-rays, a CT (computed tomography) scan or a magnetic resonance imaging (MRI) scan to get a more detailed view of your genitourinary tract.

How is pyospermia treated?

Your treatment depends on what’s causing pyospermia. In some cases, pyospermia may get better on its own.

Eliminating white blood cells from semen can improve sperm function and increase pregnancy rates. A healthcare provider may prescribe antibiotics to treat pyospermia, even if your urine and sperm cultures don’t show any bacteria. Be sure to take the full course of antibiotics. If you don’t finish the entire course, an infection can return and be more challenging to treat.

A provider may also recommend over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs may help improve your sperm count.

How can I lower my risk of developing pyospermia?

You can help prevent pyospermia by avoiding injuries to your pelvic region and reducing your risk of STIs. If you’re sexually active, it’s a good idea to:

• Use condoms whenever you have any kind of sexual intercourse.
• Avoid having sexual intercourse if you suspect a partner may have an STI.
• Get regular STI tests. Ask any new sex partners to get an STI test before having sex.

You can also try to remove excess white blood cells from your semen by:

• Avoiding the use of any tobacco products.
• Avoiding the use of marijuana.
• Drinking alcohol in moderation.

What can I expect if I have pyospermia?

With proper treatment, the outlook for many people who have pyospermia is good. After treatment, sperm quality often gets better. Talk to a healthcare provider. They can give you a better idea of what to expect.

Is pyospermia permanent?

It depends. Many people recover from pyospermia with treatment. But sometimes it persists, and healthcare providers can’t determine a cause even with treatment.

When should I see a healthcare provider?

See a healthcare provider if you and your partner aren’t able to get pregnant after at least a year of trying or if you have any symptoms of pyospermia.

Schedule and keep follow-up appointments with your provider. If the provider prescribes antibiotics, you may need a semen analysis several months after you complete the full course.

What questions should I ask a healthcare provider?

• How do you know that I have pyospermia?
• If I don’t have pyospermia, what other condition do I have?
• What’s causing pyospermia?
• What tests do you recommend?
• Should my partner get tested?
• What treatment do you recommend?

Can I still have biological children if I have pyospermia?

Pyospermia can make it more challenging to get pregnant, but it’s still possible. If you can’t get pregnant for over a year, you may have one or more other conditions (comorbidities) that make pregnancy difficult. A healthcare provider may recommend fertility treatments to help you and your partner achieve pregnancy, including in vitro fertilization (IVF) or intrauterine insemination (IUI).

A note from Cleveland Clinic

Pyospermia is when you have an unusually high number of white blood cells in your semen. It has many different causes, some of which may have painful or uncomfortable symptoms. Antibiotics, over-the-counter medications and lifestyle changes may treat some causes. More serious causes may require surgery.

You may feel nervous or awkward talking to a provider if you have symptoms that affect your genitals or you can’t achieve pregnancy. But it’s important to remember you’re not alone, and healthcare providers are here to help.