Introduction 

What is pyospermia?

Pyospermia is a condition with more white blood cells (WBC) in the semen than expected. It usually results in male infertility or reproductive issues. White blood cells are cells that are involved in your immune system. The immune system is the protective system in your body that is in charge of fighting off disease-causing bacteria and other germs. In unconventional circumstances, the body can produce too many WBCs that can negatively impact the body, such as autoimmune diseases, infections, or inflammation.

In the case of pyospermia, it could be due to the overproduction of WBCs or the presence of germs like bacteria or viruses. It is commonly caused by sexually transmitted diseases such as chlamydia or infection in the urethra.

Do lifestyle factors affect pyospermia?

Pyospermia affects 1 in 5 infertile men; therefore, measures have to be taken to prevent it.¹ Some studies have found that lifestyle factors do not impact pyospermia.² Despite this, the CDC and other regulatory bodies recommend adopting healthier lifestyle practices when attempting to conceive. This could be due to some studies finding that lifestyle factors, such as smoking and obesity, can affect pyospermia. In this article, we will explore lifestyle factors, specifically smoking, obesity, and alcohol use, on pyospermia and whether it is necessary to adopt healthy lifestyle habits to improve pyospermia.

Smoking and pyospermia 

Mechanism of pyospermia and effects of smoking

As seen in Figure 1, when the body fights off bacteria, it alerts WBCs, such as neutrophils, macrophages, lymphocytes, and monocytes, to release reactive oxygen species (ROS) and cytokines as a defence mechanism to fight off bacteria.³ This causes a phenomenon called oxidative stress, where there is excess ROS that normally helps destroy germs; however, in excess, they can damage sperm DNA or sperm cell membranes.

Smoking has been associated with increased WBCs and subsequently increased ROS in semen due to the toxins in cigarettes stimulating the WBCs to release ROS and cytokines.⁴ Smoking can also interrupt sperm movement and production, as well as sperm DNA fragmentation.

Strategies to reverse the effects of smoking

People who are diagnosed with pyospermia are often recommended to consider smoking cessation programmes, where they are guided towards abstaining from smoking. They are also prescribed antibiotics and recommended antioxidants.¹ Antioxidants are substances that can reduce ROS levels in the semen. These substances are naturally found in the semen to reduce ROS levels, although studies have shown that natural antioxidants are significantly reduced in cases of pyospermia. 

Obesity and pyospermia 

Effects of obesity on pyospermia

Obese people with a higher body mass index, or BMI (≥ 30) tend to have pyospermia. Studies have found that men with reproductive issues and with higher BMI tend to have higher WBCs in their semen. The combined effect of higher BMIs and pyospermia can affect sperm quality, such as shape and movement.⁶

People with higher BMIs tend to have more cytokines and ROS released by their immune system, which can result in inflammation or autoimmunity, where the WBCs attack healthy sperm cells. This is a result of increased adipose tissue (fat cells) in the body. Additionally, the temperature of the scrotum can rise due to increased adipose tissue in the groin and thigh region. Increased temperature can result in increased oxidative stress and sperm DNA degradation.

Hormonal imbalances, such as reduced testosterone and increased estrogen, can further affect sperm quality and increase infections and inflammations. Reduced testosterone can result in erectile dysfunction, which can subsequently result in pyospermia. This is because abstinence or lack of ejaculation can trigger the immune system to increase WBC to remove older sperm that remain in the scrotum.

Intervention approaches

Weight loss regimens are encouraged as first-line approaches that help improve testosterone levels in obese people, which in turn can reduce the effects of pyospermia. These regimens could include healthy eating habits and fitness routines. You might also be encouraged to reach out within your community to find resources that encourage you to lose weight.

Alcohol use and pyospermia 

Biological mechanisms

Excessive drinking of alcohol (> 7 units per week) can result in reduced semen quality. Alcohol use has been associated with increased WBCs, ROS and cytokine release, resulting in increased inflammation and oxidative stress, thereby affecting sperm quality as mentioned above. Studies have determined that alcohol intake can disrupt crucial steps in testosterone production, leading to a reduction in testosterone as well as stimulating the conversion of testosterone to estrogen. As mentioned above, reduced testosterone can result in exacerbation of pyospermia.

Furthermore, alcohol use has been associated with lowered antioxidant levels in the semen. Reduced antioxidant levels could result in increased ROS levels. On the other hand, alcohol use is not associated with sperm DNA degradation. 

Prevention and management

People with pyospermia are often encouraged to reduce or stop alcohol intake to prevent exacerbating oxidative stress in semen. If they have problems with alcohol use, they may be recommended to support groups. The NHS provides them with some guidance in planning their sobriety. 

Diagnosis and recommendations

The combined effects of smoking, obesity and alcohol use can have detrimental impacts on pyospermia. Studies have shown that smokers and heavy drinkers have lower-quality semen, leading to the worsening of hypospermia. 

Pyospermia is usually detected when people come into fertility centres with the hopes of getting pregnant. It is a routine procedure to determine the semen quality by analysing its sperm movement and shape, number of sperm, and concentration of round cells (WBCs). The concentration of WBCs can be determined by observing the semen under a microscope. If there are more than 1 x 10⁶ round cells per mL, there is a chance that the person has pyospermia. Further analysis is carried out to confirm pyospermia; the round cells are differentiated from other non-inflammatory cells such as degraded sperms without tails or germ cells that produce sperms.⁹ The WHO further recommends the peroxidase staining test to confirm the presence of inflammatory WBCs.

Their personal history will also be explored such as alcohol and drug use, eating habits, smoking and physical activities.  

Lifestyle modifications and interventions

When diagnosed with pyospermia, you may be prescribed antibiotics or anti-inflammatory medications such as non-steroidal anti-inflammatory drugs (NSAIDs) and antihistamines. 

Additionally, you will be recommended to change your lifestyle by eating healthier and reducing weight if you are considered obese. It is best to avoid drinking and smoking. If you struggle with any of the abovementioned factors, you will be given extra support to help stop unhealthy lifestyle habits. You should look into community-based programs for reproductive wellness or general lifestyle wellness. There are support groups that can help you with your journey with healthy eating habits. Additionally, it is recommended that you ejaculate frequently to help clear the infected semen from your system.

FAQs

Is pyospermia serious?

Pyospermia may not be life-threatening; however, it can greatly impact your fertility, as the WBCs can release cytokines and ROS that damage sperm cells.

How do I know that I have pyospermia?

People with pyospermia can sometimes be asymptomatic, while at other times, they can present with fever, scrotal swelling, yellow semen and pain while urinating. 

How often should I ejaculate to prevent pyospermia?

There is no clear number of ejaculations that is required to prevent pyospermia; however, it is not recommended to abstain longer than 3 days. 

Does having pyospermia mean that I cannot have children?

Pyospermia can damage your sperm cells, thereby affecting your fertility. However, people with pyospermia can still conceive once they have been treated with antibiotics and have adopted a healthy lifestyle. 

Summary 

There seems to be plenty of evidence linking smoking, obesity and alcohol use to pyospermia. Smoking is suspected of releasing toxins into the body that cause increased WBC production in the semen, subsequently leading to higher oxidative stress. Obesity results in adipose tissues increasing WBC production and scrotal temperature, leading to inflammation. Alcohol use can also trigger an inflammatory response in the semen, causing pyospermia.Although, further studies are needed to determine whether there are long-term benefits to improving lifestyle factors. People who are trying to conceive with pyospermia or want to treat their pyospermia are recommended smoking cessation groups if they smoke. Supports groups or community-based programmes that can help maintain a healthy lifestyle, and there are alcohol support groups for people who want to get sober. All of these measures can help significantly improve semen quality.