Overview

Abnormalities, especially in sexual function, can be very embarrassing to talk about. 

Pyospermia is one such condition. A health issue that can raise concerns about a man's fertility and sexual well-being.

Normally, the human body has white blood cells (WBCs) that fight infections. However, when these cells accumulate excessively in a place they should not, such as semen, it signifies an underlying problem.

In this article, you will learn what pyospermia means, the prognosis, and the outcome after treatment.

What is pyospermia?

Pyospermia (or leukocytospermia) occurs when there is an abnormal or excessive number of WBCs in semen. Semen is the fluid ejaculated from the penis during orgasm, typically during sexual activity. It contains a mixture of nutrients that nourish the sperm. The body's defence system produces WBCs that destroy harmful organisms which cause infections. An abnormally high WBC count in semen can indicate infection or inflammation¹, which may affect fertility by impairing semen quality. The number of WBCs in semen for pyospermia to be concluded is disputed, but when there are more than a million in a millilitre of semen, it's abnormal and depicts pyospermia.¹ High white blood cells are always related to pyospermia, low sperm cells, and decreased normal forms.⁵ Hence, it can be a hidden cause of male infertility.⁴

Causes of pyospermia 

While elevated white blood cells in semen are often associated with infection or inflammation, pyospermia can also result from a range of other underlying causes.

Infections and inflammatory conditions

• Can be bacterial, fungal, and viral infections⁵,⁶
• Genital infections like Chlamydia trachomatis and Gardnerella vaginalis in one's sexual partner¹⁰
• Chronic prostatitis¹
• HIV, which compromises immunity⁹
• Autoimmune disorders¹

Anatomical or congenital abnormalities

• Varicocele
• Posterior urethral valves¹

Lifestyle and environmental factors

• Smoking¹,⁶
• Alcoholism¹,⁶
• Drug abuse (e.g., marijuana, tobacco)¹
• Irritants and toxins¹,⁹

Sexual and reproductive factors

• Poor sperm viability¹,⁹
• Abstinence (for a long time, hence no ejaculation)⁹
• Use of vaginal products by partners during intercourse⁹

Medical or surgical interventions

• Vasovasostomy⁹
• Urethroplasty⁹
• Trauma like spinal cord injury⁶

A study reported that people assigned male at birth living with diabetes mellitus and hypertension had higher white blood cell counts in their semen compared to healthy individuals. It means these conditions might lead to more vulnerability for pyospermia.

Symptoms of pyospermia 

Most times, pyospermia manifests without symptoms, while symptoms like pelvic pain, painful urination, and ejaculation can also be present.

How does it occur? (mechanism)

WBCs in semen primarily originate from the epididymis, where they help monitor the immune system and eliminate bad sperm cells. As they carry out these functions, they generate harmful chemicals known as reactive oxygen species (ROS). ² ⁶ These ROS destroy the fatty layer surrounding sperm which causes defects in sperm cells, damaging many parts or components of the cell in various ways.³ It can damage the tail function, affecting sperm motility.⁶

ROS can disrupt the DNA and RNA (the brain of the cell) as well as protein components, affecting the intracellular energy production of the cell.³ With decreased energy, cell activities like movement can suffer.⁹ Pyospermia can also affect how sperm are produced and how they grow.⁶ This has extended effects on sperm volume, concentration, count, movement, vitality, structure, viscosity and pH.³ It can also affect the sperm cell's ability to fertilise the egg by interfering with fertilisation reactions.⁶

How is pyospermia diagnosed?

During diagnosis, the patient's history is first taken, and physical observation is done. 

Subsequently, the following tests are carried out: 

Semen analysis: Primary test where the semen sample is collected (usually by ejaculation) and analysed using a microscope. If there are more than a million white blood cells found in a millilitre, it is usually diagnosed as pyospermia.

• Peroxidase test: Conducted for confirmation to differentiate WBCs from immature stem cells in the semen by brown staining³
• Culturing semen samples: Once pyospermia is confirmed, the semen sample is checked for bacteria to understand the cause³
• Immunohistochemical staining: Accurate method for detecting WBCs in semen. It involves using monoclonal antibodies which target specific WBC subpopulations⁶,⁹

The impact of WBCs depends on when and where they enter the semen, the type of WBC involved, the amount, and the activation state.⁹

Treatments

There is no definitive medical treatment for pyospermia because the exact underlying causes of the condition often cannot be determined.⁹ The available treatment options often include antibiotic treatment, antioxidants, and anti-inflammatory medications. ⁶ In cases of infections caused by bacteria, broad-spectrum antibiotics are used for treatment.⁷,⁸ The European Association of Urology states antibiotics may improve the overall quality of spermatozoa (sperm). ⁶ Antioxidants such as tocopherol (vitamin E), vitamin C (ascorbate) and carotenoids directly target the ROS produced as a result of inflammation, protecting the sperm membrane and DNA from destruction.⁷,⁹

Medications such as calcium dobesilate, propofol, and rebamipide are also helpful.⁹

Frequent ejaculation plays a role too.¹,⁹ It helps to remove stored secretions, which may increase antibiotic effectiveness and minimise inflammation.¹

Ketotifen, an antihistamine-like drug, helps improve sperm motility and structure.⁸

Nonsteroidal anti-inflammatory drugs (NSAIDs) restore sperm count, movement and structure in pyospermia.¹

Other treatment options include surgery to improve urine flow and physical therapy.¹

Prevention 

To keep pyospermia at bay, avoid anything that can cause infection or inflammation.

Other measures that can be taken include:

• Regular screenings
• Promote healthier lifestyles by preventing smoking and excessive alcohol consumption
• Drinking enough water to help eliminate toxins that can cause infections
• In the case of varicocele, treatment is urgently required
• Treat any infection or disease promptly

Prognosis

Pyospermia is a disease with underlying causes. If detected and treated early, the condition generally has a favourable prognosis. Several clinical guidelines support the use of antibiotic treatments, noting improvements in sperm quality and enhanced pregnancy outcomes.¹ A study also shows that in cases of pyospermia associated with infertility, treatment with antibiotics has a significant resolution compared to untreated controls.¹ Antibiotic treatment also had a clear effect on the volume and pH of seminal fluid after 30 days of treatment. ¹ Ketotifen had improved effects of pyospermia at the fourth week of use for treatment and at eight weeks of treatment; movement and structure improved significantly.¹ NSAIDs improve sperm movement and structure.¹ This indicates that the treatment of pyospermia with drugs has a good outcome.

Outcome after treatment 

Treatment of pyospermia, particularly when guided by appropriate medical therapy, shows promising outcomes in improving fertility potential. The resolution of infection and inflammation often leads to significant enhancements in seminal parameters.⁶ Notable improvements include increased seminal volume, normalisation of pH, and substantial gains in sperm concentration. Motility also improves after treatment, although these changes may be gradual, they mean better fertility prospects. A study reports couples have indicated higher rates of natural conception and improved success with assisted reproductive techniques following treatment.⁶ Also, in situations where antibiotics and frequent ejaculation were used as treatments, successful pregnancies have also been achieved.¹ With timely and targeted intervention, the prognosis for fertility restoration in persons assigned male at birth with pyospermia is optimistic, especially when the underlying cause is identified and appropriately managed.

FAQs 

Is pyospermia a sign of infertility?

Not always, but it can lead to a decline in fertility by damaging sperm cells' motility, structure and DNA.

Is pyospermia hereditary?

Pyospermia is not seen as a hereditary disease, but some underlying conditions that may contribute to it, such as autoimmune disorders or anatomical abnormalities have genetic components.

Can pyospermia affect testosterone levels?

Pyospermia typically does not directly affect testosterone levels. However, if it’s linked to infections or testicular damage, hormonal imbalances may occur indirectly.

Is pyospermia contagious or infectious to a partner?

Pyospermia is not contagious but if it is caused by an STI or infection, the pathogen may be transmissible to a sexual partner.

Can it reoccur after successful treatment?

Yes, if the underlying cause is not fully treated or if reinfection or inflammation happens again.

Are there any complications if left untreated?

Untreated pyospermia can lead to chronic inflammation, ongoing fertility issues, and, in some cases, damage to reproductive organs.

Summary

Pyospermia, also known as leukocytospermia, occurs when the number of WBCs in semen is above normal. The condition may indicate infection or inflammation in the urogenital tract and can cause fertility issues. It has various causes but can be deeply rooted in infection or inflammation because of the increased WBCs any time any of these occur. Although asymptomatic, it can show different symptoms like pelvic pain and yellowish semen. Early diagnosis is important for treatment. When treated early, the prognosis is good, and most patients significantly improve in semen quality and fertility.