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Diseases & Conditions

Pyospermia

Pyospermia (also referred to as leukocytospermia) is a condition in which there is an unusually high number of white blood cells in the semen. According to the World Health Organization, pyospermia is defined as more than 1 million white blood cells per milliliter of semen.

Pyospermia is an important condition in male fertility because white blood cells weaken the sperm and can damage its genetic material. White blood cells release powerful substances called reactive oxygen species (ROS), which destroy organisms that cause infections. Unfortunately, ROS can also affect healthy tissues, which includes sperm. ROS destroy the sperm membrane, impair sperm movement, and damage sperm DNA.

How common is pyospermia?

Less than 5% of men with a fertility problem are diagnosed with pyospermia.

What causes pyospermia?

Pyospermia can be caused by many different things, including:

  • infection
  • inflammation (swelling)
  • autoimmune conditions (the body attacks itself)
  • urethra stricture (narrowing of the tube through which urine passes)
  • genital infections, such as herpes, gonorrhea, or chlamydia
  • varicocele (the veins coming from the testicle are dilated, or widened)
  • systemic illness (across the whole body)
  • infrequent ejaculation
  • use of tobacco, marijuana, and alcohol

Infections in the genitourinary system are one potential cause for pyospermia. Common organisms include E. coli, Mycoplasma, Ureaplasma, and Chlamydia. While most people with genitourinary infection will have symptoms, up to 10% of young adults will have no symptoms or only mild symptoms.

Because some genital infections can be passed through sexual contact and can usually be treated successfully, all men who are diagnosed with pyospermia should have urine tests to look for organisms that cause infection within the genitourinary tract.

Infections in the female reproductive tract can cause serious and permanent fertility problems. Therefore, even though the risk of having an infection is very low, men should wear a condom during intercourse until the urine tests show that there is no infection. In cases where the tests reveal an infectious organism, the spouse or partner should also be tested and treated.

How is pyospermia treated?

Eliminating white blood cells from the semen can improve the function of the sperm and improve pregnancy rates. Because antibiotics may help treat pyospermia, men may receive a prescription for antibiotics and told to take the entire course, even if no organisms are found in the urine. In rare cases, a culture of the semen may be taken.

Nonsteroidal anti-inflammatory medications (NSAIDs) are also prescribed for patients with pyospermia, and may also improve sperm count. Pyospermia may also get better on its own.

There are other things men can do to try to eliminate excess white blood cells from semen, including:

  • stopping the use of any tobacco product;
  • avoiding the use of too much alcohol;
  • stopping the use of marijuana;
  • more frequent ejaculation.

The use of the antioxidant nutritional supplements can reduce sperm production and lessen the effects of white blood cells in the semen. Men who are trying to make a pregnancy and who have pyospermia should consider taking antioxidant nutritional supplements, including vitamin E, vitamin C, Coenzyme ubiquinol-10 (CoQ10), glutathione, and others.

Pyospermia can also be treated by correcting genitourinary abnormalities that may cause infection or inflammation. Methods of correction include varicocelectomy, the surgery to correct a varicocele, which can improve semen production and reduce white blood cells in the semen. Other abnormalities that can be treated include prostatic obstruction with infection and urethral valves.

Follow-up

Another semen analysis three months after the antibiotics are completed is recommended as a follow-up. If the pyospermia has not been treated successfully, other measures include semen cultures, antisperm antibody testing, x-rays of the genitourinary tract, and/or urine flow tests. In many cases, treatment for 30days with an over-the-counter nonsteroidal anti-inflammatory medication may be recommended.

References

Lackner J, Herwig R, Schmidbauer J, et al.Correlation of leukocytospermia with clinical infection and the positive effect of anti-inflammatory treatment on semen quality.FertilSteril. 2006; 86(3): 601-605.

Pentyala S, Lee J, Annam S, et al.Current perspectives on pyospermia: a review. Asian J Androl. 2007; 9(5): 593-600.

© Copyright 1995-2013 The Cleveland Clinic Foundation. All rights reserved.

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 5/9/2013…#15220

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