Pyospermia And Male Reproductive Health

  • Vivien Karen MokBachelor of Science – Biomedical Science, King's College London
  • Jasmine AbdyBachelor of Science - BSc, Medical Microbiology with a Year in Industry, University of Bristol

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Various reasons could explain male infertility, with pyospermia being one of them. If left untreated, pyospermia could cause fertility issues and impact couples’ ability to conceive. Addressing pyospermia is essential for ensuring reproductive health and supporting couples' aspirations for starting a family. Knowledge and practice of maintaining male reproductive health plays a big part in not only preventing infertility issues but also the overall health of the body. 

Introduction to pyospermia 

Pyospermia, also known as leukospermia, is the presence of pus cells (pyocyte) and or white blood cells (leukocyte) in the semen.1 The condition represents a negative impact on bulk semen parameters and fertilisation. In the semen analysis of males with an investigation for infertility, 23% showed pyospermia.2 Often, pyospermia is caused by bacterial infection in the genitourinary tract.

Hence antibiotics are prescribed to treat the condition, which have been shown to improve fertility rate temporarily. Male reproductive health has paramount importance for the overall well-being of individuals. As males play a crucial role in achieving reproductive success for couples desiring to start a family, issues relating to infertility such as low sperm count, poor sperm motility, and abnormal sperm morphology can negatively impact an individual's self-esteem and confidence. Stressing the importance of developing a better curriculum on male reproductive health in sex education would play a crucial role in overcoming barriers to conception. 

Causes of pyospermia

Anatomical obstruction and inflammatory responses occur due to infections of the male genitourinary tract. Even a low-grade infection is enough to trigger an anti-spermatozoal immune inflammatory response which could damage spermatozoa.3 Non-specific inflammatory response includes the release of leukocytes which increases the levels of oxidative stress and decreases sperm quality and count.

Triggering an inflammatory response also causes swelling near the area infected. Some examples are:

  • inflammation in your urethra (urethritis)
  • prostate (prostatitis)
  • seminal vesicles (seminal vesiculitis)

All of these locations of inflammation could play a part in the narrowing of the urethra (urethral stricture), causing anatomical obstruction in the reproductive tract.4

Some lifestyle factors that could cause this condition are:5 

  • Smoking cigarettes 
  • Alcohol intake
  • Use Of illicit drugs
  • Obesity
  • Psychological stress
  • Dietary practices
  • Coffee consumption
  • Testicular heat stress
  • Lack of sleep
  • Exposure to electromagnetic radiation from mobile phone use
  • Practise of unsafe sex 

All of these factors are associated with changing DNA through methylation. Genetics is also a factor that plays a part in infertility in males, specifically inherited disease and specific abnormalities in the Y chromosome. 10-20% of males struggling with infertility related to lack of sperm in ejaculate carry a deletion of the Y chromosome, perhaps in a region associated with testicular histology.

Male infertility results from random attacks by reactive oxygen species (ROS) or free radicals on the naked mitochondrial DNA (mtDNA) of sperm, which would inevitably induce oxidative damage or mutation to the mitochondrial genome with catastrophic implications.6 

Symptoms of pyospermia

Leukospermia itself is asymptomatic and can only be detected via a sperm analysis. However, some symptoms of genitourinary tract infection are as follows: 

  • Changes in semen appearance: Semen could appear discoloured, sometimes yellow
  • Pain or discomfort in the genital area: Infections causes swelling in the area of the penis or groyne. Widened or dilated varicocele coming from the testes is also a sign of infection
  • Fertility issues: Infrequent ejaculation and reduced fertility

Diagnosis of pyospermia

The andrologist would ask for the medical history of the patient to thoroughly understand the patient's condition and consider different treatment plans. Physical examinations are also possible to find abnormalities such as tenderness and swelling on the external genitalia and reproductive organs, which could signify a bacterial infection. 

Semen analysis is also a typical procedure following the andrologist appointment. Semen is collected and incubated immediately for more effective curation, and 3 to 7 days of abstinence is required.7 The sample of semen is incubated at 37 degrees Celsius for an hour for liquefaction. The samples are then analysed based on benchmarks. According to the National Institute for Health and Care Excellence, the following factors represent the range that is considered healthy:8 

  • Volume = more than 1.5 ml
  • pH = more than 7.2
  • Total sperm number = 39 million sperm per ejaculate or more
  • Morphology = more than 4% normal forms using the Tygerberg method 
  • Vitality = more than 58% live sperm
  • Progressive motility = more than 32%
  • Total (progressive motility and non-progressive motility) = more than 40% 
  • No sperm agglutination
  • Viscosity = more than 2 cm after liquefaction 

After four hours, smears of the specimen are prepared to study the sperm morphology. Through this analysis, the presence of pyospermia can be identified. Surpassing 1 million leukocytes per ml of semen would be classified as pyospermia.9 Cultures and imaging of the semen specimen allow identification of not only leukocyte presence but also microorganisms. The microorganisms could be the reason for genital inflammation. Some examples of such microorganisms are E. Coli and Chlamydia trachomatis. 

Treatment options

The following bullet points highlight the main treatments often administered and suggested to patients struggling with infertility and pyospermia. 

Medication

The medication prescribed can be either antibiotics to fight the bacterial infection or it can be anti-inflammatory to reduce the swelling and soreness of the genitourinary tract. A long course of antibiotics of 4 to 6 weeks is usually prescribed. Empiric antibiotics are administered to target typical organisms that cause bacterial infection. These include tetracyclines (i.e. doxycycline), sulfonamides (i.e. Bactrim), and quinolones (i.e. ciprofloxacin).

For anti-inflammatory medication, antihistamines and or ibuprofen are often prescribed to reduce swelling and prevent excess histamine produced from the immune response to the inflammation. Antioxidants are also prescribed to reduce attacks by reactive oxygen species (ROS) or free radicals on the naked mitochondrial DNA. 

Surgical intervention

Surgical intervention is also possible for physically getting rid of anatomical obstructions. An example of this is the surgical correction of congenital abnormalities, specifically the removal of cysts or tumours obstructing the reproductive structures. 

Lifestyle modification

Not limited to reproductive health, eating well-balanced meals and healthy food improves the quality of life and general health of the body. Hypercaloric diet causes obesity which in turn increases the risk of infertility.10 Alcohol and caffeine intake should also be restricted as spermatozoa exposure to alcohol and caffeine showed harmful effects on sperm motility and morphology.

Cigarette smoke contains carcinogenic elements and is highly associated with leukocytospermia. Smoking itself is a major endogenous source of ROS, and a high ROS can overwhelm endogenous antioxidant defences.11 This can be visualised by statistics, where male smokers have a concentration of sperm 13-17% lower than non-smokers.12 Practising monogamous relationships or reducing sexual partners can also reduce the chances of exposure and contraction of STDs. 

Complications of pyospermia

Recurrent infections could lead to a chronic condition of discomfort and pain in the groyne area if left untreated. In addition, if repeated courses of antibiotics are ineffective, there is a good chance of leading to antibiotic resistance. Repeated courses of antibiotics also negatively impact the rest of the body, especially causing an imbalance in microorganisms. 

A big complication of infertility is the psychological impact one could experience. If an individual perceives reproductive health as a fundamental aspect of masculinity and their identity as a male, then they could experience feelings of inadequacy, failure, or loss. While grappling with societal expectations and personal aspirations related to parenthood and family-building, infertility can be a challenging and frustrating experience for couples looking to start a family. 

Prevention strategies

Practise safe sex

Pyospermia is said to be caused by bacterial infection potentially from sexually transmitted diseases. Practising safe sex would prevent bacterial infection from worsening and spreading to others. This includes the consistent and correct use of contraceptives like condoms, which reduces the risk of sexually transmitted infections (STIs) that can cause inflammation and infections in the reproductive tract. Minimising sexual partners and knowledge of sexual partners’ sexual history also helps with mitigating the spread of STIs. 

Maintain good hygiene

Regular and thorough cleaning of the genital area removes sweat and debris that can accumulate and create an environment conducive to bacterial growth and infections. Maintaining appropriate hydration, eliminating the bladder on a regular basis, and engaging in safe sexual behaviour to avoid UTIs are all examples of good urinary tract hygiene that can help lower the risk of infections that could progress and impact the reproductive system. 

Regular medical check-ups

See a local andrologist periodically to ensure the maintenance of healthy male reproductive health. Asking for advice and knowledge towards preventing infertility also helps clear up misunderstandings and stigma surrounding this topic. 

Sex education including male reproductive health

Sex education also plays a big part in developing awareness of male reproductive health and its importance. Individuals can take proactive actions to prevent reproductive health issues, such as STIs, infertility, and conditions like pyospermia, by being aware of risk factors, preventive measures, and good behaviours. Education also plays a crucial role in challenging societal stigma and discrimination associated with reproductive health issues. This includes awareness towards infertility, sexually transmitted infections, and conditions like pyospermia. 

Research and future directions

There are rather few studies on pyospermia as it is a consequence of sexually transmitted infections (STIs). Instead, there are more studies being put into STDs and how to treat them through drugs or procedures. A potential advancement in regard to the treatment and prevention of STIs is the research development of drugs that surpass antibiotic resistance. Some specific examples of drugs with antimicrobial resistance are Ceftriaxone which is oral therapy for gonorrhoea, and Moxifloxacin – a drug for Mycoplasma genitalium.13 

To battle infertility, assisted reproductive techniques (ART) for people with fertility issues are also becoming increasingly popular and affordable. In-vitro fertilisation (IVF) is the most common ART. It essentially involves fertilising the egg with sperm in a lab without involving the usual procedure of sexual intercourse.

Through IVF, the chances of fertility increase substantially and allow couples to start a family. Some other examples of ART are embryo culture, embryo transfer, and intracytoplasmic sperm injection. Cryopreservation is also an increasingly popular ART where vitrification is used to freeze egg cells for fertility preservation. 

Sex education is also constantly evolving alongside the development of research. This raises awareness towards the general knowledge of reproductive health and also promotes the importance of sex education. The lack of education leads to practices of unsafe sex, lack of good personal hygiene, and ignorance towards the consequences of STIs. 

Summary

Bacterial infections in the genitourinary tract are a common cause of pyospermia, which can impair sperm count and quality by causing anatomical blockages, inflammation, and oxidative stress. Its development is influenced by a number of factors, including exposure to infections, genetic predispositions, and lifestyle choices. Medications, lifestyle changes, and surgery are forms of treatment to mitigate symptoms.

Pyospermia treatment is essential for maintaining male reproductive health and assisting couples in fulfilling their goal of becoming parents. It is important to emphasise the significance of comprehensive sex education and continuous research efforts in this sector. Education and awareness play a significant role in encouraging preventive measures and overcoming barriers to conception.

References

  1. Velez D, Ohlander S, Niederberger C. Pyospermia: background and controversies. F S Rep. 2021; 2(1):2–6.
  2. Jarvi K, Noss MB. Pyospermia and male infertility. Can J Urol. 1994; 1(2):25–30.
  3. Morell V. Attacking the Causes of “Silent” Infertility. Science [Internet]. 1995 [cited 2024 Feb 20]; 269(5225):775–7. Available from: https://www.science.org/doi/10.1126/science.7638588.
  4. What Is Pyospermia? Cleveland Clinic [Internet]. [cited 2024 Feb 20]. Available from: https://my.clevelandclinic.org/health/diseases/15220-pyospermia.
  5. Durairajanayagam D. Lifestyle causes of male infertility. Arab J Urol [Internet]. 2018 [cited 2024 Feb 20]; 16(1):10–20. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5922227/.
  6. Poongothai J, Gopenath TS, Manonayaki S. Genetics of human male infertility. Singapore Med J. 2009; 50(4):336–47.
  7. Sunder M, Leslie SW. Semen Analysis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Feb 20]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK564369/.
  8. Quality statement 4: Semen analysis | Fertility problems | Quality standards | NICE [Internet]. 2014 [cited 2024 Feb 20]. Available from: https://www.nice.org.uk/guidance/qs73/chapter/quality-statement-4-semen-analysis#:~:text=semen%20volume%3A%201.5%20ml%20or,spermatozoa%20per%20ejaculate%20or%20more.
  9. Reus R. Leukocytospermia or Pyospermia - Causes & Treatment. inviTRA [Internet]. 2023 [cited 2024 Feb 20]. Available from: https://www.invitra.com/en/analysis-of-the-amount-of-leukocytes-in-semen-and-sperm-culture/.
  10. Kahn BE, Brannigan RE. Obesity and male infertility. Curr Opin Urol. 2017; 27(5):441–5.
  11. Centers for Disease Control and Prevention (US), National Center for Chronic Disease Prevention and Health Promotion (US), Office on Smoking and Health (US). How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General [Internet]. Atlanta (GA): Centers for Disease Control and Prevention (US); 2010 [cited 2024 Feb 20]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK53017/.
  12. Vine MF, Margolin BH, Morrison HI, Hulka BS. Cigarette smoking and sperm density: a meta-analysis. Fertil Steril. 1994; 61(1):35–43.
  13. Wilkins NJ, Rasberry C, Liddon N, Szucs LE, Johns M, Leonard S, et al. Addressing HIV/Sexually Transmitted Diseases and Pregnancy Prevention Through Schools: An Approach for Strengthening Education, Health Services, and School Environments That Promote Adolescent Sexual Health and Well-Being. J Adolesc Health. 2022; 70(4):540–9.

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Vivien Karen Mok

Bachelor of Science – Biomedical Science, King's College London

Vivien is a Biomedical Science student and a dedicated advocate for regenerative medicine and healthcare communication. She harnesses a profound passion for advancing research and making healthcare accessible to all. Using her prior experience writing on platforms, Vivien has ventured into the field of medical communications with the goal of amplifying voices and reaching a wide range of audiences with important information.

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