What Is Pyospermia


Pyospermia, also known as leukocytospermia (loo-koh-cy-toh-spur-mia), is a condition where those assigned male at birth (AMAB) have high numbers of white blood cells in their semen. Pyospermia can affect the fertility of AMAB individuals.1 Infertility affects roughly 15% of couples that try to conceive, with half of these attributed to infertility of AMAB individuals.1,2,3 Pyospermia is common among AMAB individuals; some studies suggest that it affects almost 20% of AMAB individuals who undergo testing for fertility and have other concerns regarding their reproductive system.1 The reproductive and urine systems make up the urogenital tract, and multiple underlying issues in the tract can cause pyospermia. While there can be many underlying causes, the common feature is that they lead to inflammation.1,4 Signs and symptoms of pyospermia include pain and inflammation in the pelvic area or genitals, unusual colour or consistency of semen, and other urogenital infections.1,5 Pyospermia can also be asymptomatic.6,7 Treatment of pyospermia often involves a combination of antibiotics, anti-inflammatory medications, and regular ejaculation.1,2 To prevent and treat pyospermia, lifestyle modifications can be made that are also necessary when trying to conceive.4 Continue reading to familiarise yourself with the causes, symptoms, and treatments if you think you have pyospermia.

Causes of pyospermia

Pyospermia is caused by several factors that compromise the male reproductive system. Inflammation by the immune system is often the major underlying cause of pyospermia and other fertility issues in AMAB individuals.1 Normally, inflammatory cells break down and remove abnormal sperm cells to ensure a rich environment for healthy sperm and improved fertility.1,7 However, excessive and unnecessary inflammation can put stress on the reproductive system, in particular sperm function, causing pyospermia.1 Inflammation is sometimes caused by viral or bacterial infections. These urinary tract infections (UTIs) can become long-term or ‘chronic’, leading to pyospermia.8

More commonly, pyospermia is caused by factors that lead to chronic inflammation; this is true for around 80% of AMAB people with the condition.1,4,8 Chronic inflammation is ongoing, low-grade inflammation that results in a multitude of health issues, usually with an underlying cause or disease. Inflammatory conditions that may contribute to the occurrence of pyospermia include the following:

Other conditions that may cause pyospermia include:

  • Toxins from the environment, tobacco, alcohol, or marijuana1,4
  • Poor sperm viability1
  • Obstructive causes10
  • Spinal cord injuries10
  • Obesity1,4

Symptoms of pyospermia

Pyospermia can present in a few different ways; some symptoms are relatively subtle, whereas others are more noticeable and concerning. Pyospermia can also be completely asymptomatic, along with any commonly associated infections .5 Pyospermia may then lead to fertility issues that are only diagnosed when those issues are investigated.3,5

Symptoms include:

  • Pelvic pain1
  • Painful ejaculation1
  • Pain or discomfort in the genital area1
  • Pain or discomfort when urinating
  • Swollen testicles or genital area
  • Yellow-orange semen6
  • Highly viscous (thick) semen6

Other signs of pyospermia include the inflammatory conditions listed in the previous section. Varicocele, epididymitis, prostatitis, and other chronic inflammatory diseases can be markers of pyospermia when they are diagnosed, as well as the cause of the condition.1,4,7

Diagnosis of pyospermia

Pyospermia is diagnosed through physical examinations. Usually, two semen samples are collected. Laboratory tests are then carried out to analyse semen volume, pH level (acidity or alkalinity), sperm concentration, colour, movement and shape of sperm cells, and round cell count, which corresponds to white blood cells and immature sperm cells.1,2,9 One of the main diagnostic indicators of pyospermia is a high white blood cell count that indicates inflammation.1,9 Secondary testing is done on these samples to determine how many of these cells are causing inflammation.1 The presence of bacteria and viruses is highly correlated with pyospermia and is a strong indicator of the condition.1,5,9,10 Secondary testing of the semen is completed after your treatment plan to ensure that it has been successful.

Complications and risks

Pyospermia is present in 20% of AMAB individuals with fertility issues, and many studies suggest that these issues are no coincidence. Studies have found that treatment of pyospermia leads to healthy sperm shape, mobility, and count.2 However, without treatment, it has been shown that conception is less likely.

After diagnosis, healthcare professionals usually investigate your medical history to establish any underlying issues or factors that could have caused your pyospermia, as it can sometimes be a marker for an underlying inflammatory disease.1,2 Sexually transmitted diseases (STDs) such as chlamydia or gonorrhoea can often accompany pyospermia and affect sexual health.7

Studies have suggested that pyospermia doesn’t implicate fertilisation technologies like in vitro fertilisation (IVF). However, this isn’t definitive, so it may be beneficial to get the condition under control before continuing with these kinds of procedures, as they can be extremely costly.1

Treatment options

There are several ways to treat pyospermia, depending on the cause. Anti-inflammatory drugs may be prescribed to reduce inflammation in the urogenital tract.1 This reduces the effects of pyospermia; however, in many cases, it may not treat the underlying cause of inflammation.1 Commonly, antihistamines or nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g. ibuprofen) are used.1 Steroidal anti-inflammatory drugs have been investigated as well, but they are not sufficient to help pyospermia.2

A common and often successful treatment involves a course of antibiotics combined with frequent ejaculation.1,2 Antibiotics fight any bacterial infections in the urogenital tract, and frequent ejaculation is thought to clear any immune system substances in the urogenital tract that are blocking the pathways.1 Ejaculation is also suspected to reduce inflammation.1

It is important to seek advice and medical care when you experience any symptoms or have concerns about your reproductive health. Furthermore, it is imperative to adhere to treatment plans recommended by your doctors as well as incorporate healthy lifestyle choices to ensure that your pyospermia is kept under control.

Lifestyle modifications and prevention

e Some lifestyle modifications may be recommended to you in conjunction with treatment, to either manage the condition or reduce your chances of developing pyospermia.1,4,10 These are also necessary precautions to take before trying to conceive.4 It is recommended that alcohol, tobacco, illicit drugs, and marijuana consumption be stopped or at least substantially reduced.1,4 The use of spas and saunas should be minimised, and tight underwear should be avoided due to the stress put on the genitals by excessive heat.1,4 Instead, it is recommended to wear loose-fitting boxer shorts.4 Obesity can also be a risk factor in both infertility and pyospermia, so maintaining a healthy weight through diet and exercise is also recommended.1,4 These treatments and lifestyle modifications have been shown to improve sperm count, mobility, and shape in multiple studies.2,4

Underlying causes like inflammatory diseases that are uncovered during the diagnosis of pyospermia should be treated and may involve ongoing lifestyle modifications to keep the inflammatory diseases under control, improve fertility, and maintain overall health.1,4 Receiving regular health check-ups with your doctor will ensure that if you do develop pyospermia, it is dealt with in an appropriate time frame without impacting your fertility.


Pyospermia, or leukocytospermia, affects male fertility, with signs and symptoms presenting in around 20% of AMAB individuals undergoing fertility tests. Inflammation is the main underlying condition that causes pyospermia. It is often triggered by infection by bacteria or viruses, chronic inflammatory diseases, chronic prostatitis (inflamed prostate gland), or varicocele (enlarged blood vessels). Symptoms will range from changes in semen colour or consistency to pelvic pain, as well as painful ejaculation. Some people can also be asymptomatic, making a diagnosis less likely. Diagnosis involves analysing semen samples for white blood cells, infection, and sperm characteristics. Treatment will usually involve a prescription of antibiotics, anti-inflammatory medication, and frequent ejaculation.

There can be implications associated with pyospermia along with infertility, potentially indicating inflammatory conditions or STDs. This highlights the importance of regular health check-ups, particularly when trying to conceive to minimise fertility issues. Lifestyle changes such as avoiding tight underwear, reducing alcohol and drug consumption, and maintaining a healthy weight can be preventative or improve the outcome during treatment of pyospermia.


  • Velez D, Ohlander S, Niederberger C. Pyospermia: background and controversies. F S Rep [Internet]. 2021 Jan 11 [cited 2024 Jan 1];2(1):2–6. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8244362/ 
  • Brunner RJ, Demeter JH, Sindhwani P. Review of guidelines for the evaluation and treatment of leukocytospermia in male infertility. World J Mens Health [Internet]. 2019 May [cited 2024 Jan 7];37(2):128–37. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6479086/ 
  • Ligny W, Smits RM, Mackenzie-Proctor R, Jordan V, Fleischer K, Bruin JP, et al. Antioxidants for male subfertility. Cochrane Database Syst Rev [Internet]. 2022 May 4 [cited 2024 Jan 8];2022(5):CD007411. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9066298/ 
  • Komiya A, Kato M, Shibata H, Imamura Y, Sazuka T, Sakamoto S, et al. Results of lifestyle modification promotion and reproductive/general health check for male partners of couples seeking conception. Heliyon [Internet]. 2023 Apr 5 [cited 2024 Jan 7];9(4):e15203. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10114203/
  • Zhang QF, Zhang YJ, Wang S, Wei Y, Li F, Feng KJ. The effect of screening and treatment of Ureaplasma urealyticum infection on semen parameters in asymptomatic leukocytospermia: a case–control study. BMC Urol [Internet]. 2020 Oct 22 [cited 2024 Jan 8];20:165. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7579809/ 
  • Mason MM, Schuppe K, Weber A, Gurayah A, Muthigi A, Ramasamy R. Ejaculation: the process and characteristics from start to finish. Curr Sex Health Rep [Internet]. 2023 Mar [cited 2024 Jan 8];15(1):1–9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9997041/
  • Sharma R, Gupta S, Agarwal A, Henkel R, Finelli R, Parekh N, et al. Relevance of leukocytospermia and semen culture and its true place in diagnosing and treating male infertility. World J Mens Health [Internet]. 2022 Apr [cited 2024 Jan 8];40(2):191–207. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8987138/ 
  • Yao Y, Qiu XJ, Wang DS, Luo JK, Tang T, Li YH, et al. Semen microbiota in normal and leukocytospermic males. Asian J Androl [Internet]. 2021 Dec 10 [cited 2024 Jan 8];24(4):398–405. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9295480/ 
  • Eini F, Kutenaei MA, Zareei F, Dastjerdi ZS, Shirzeyli MH, Salehi E. Effect of bacterial infection on sperm quality and DNA fragmentation in subfertile men with Leukocytospermia. BMC Mol Cell Biol [Internet]. 2021 Aug 13 [cited 2024 Jan 8];22:42. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8364116/ 
  • Khodamoradi K, Kuchakulla M, Narasimman M, Khosravizadeh Z, Ali A, Brackett N, et al. Laboratory and clinical management of leukocytospermia and hematospermia: a review. Ther Adv Reprod Health [Internet]. 2020 Jun 11 [cited 2024 Jan 8];14:2633494120922511. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7290265/ 
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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