Pyospermia is the presence of pus in the ejaculate, that is, leukocytes in large quantities. Despite the fact that sometimes this condition can be detected with the naked eye, most often pyospermia is detected during spermograms. The appearance of leukocytes in the ejaculate affects the mobility and function of the sperm, which can cause infertility, while other indicators of sperm are normal.
Pathology is the content of more than 1 million (1x10 6 ) leukocytes in 1 ml of ejaculate. This condition indicates the inflammatory process in the lower urinary tract. Most often it is the posterior urethra, prostate gland, epididymis, seminal vesicles.
Allocate true and false pyospermia:
- in true pyospermia, pus is evenly mixed with the ejaculate, which acquires a greenish-yellow color and an unpleasant odor.
- with false pyospermia, leukocytes join the sperm during its passage through the urethra, while often the appearance of the ejaculate does not change.
During microscopy, in addition to leukocytes, bacteria and desquamated epithelial cells are often detected in the ejaculate. Often, pyospermia is combined with hemospermia , asthenoteratozoospermia.
Leukocytes and substances released during active inflammation disrupt the function of spermatozoa. A negative post-oxidative test is often detected — that is, sperm cells lose their ability to survive in cervical mucus. Their mobility also decreases. All this together can lead to infertility. On average, 23% of men undergoing screening for infertility showed pyospermia.
Inflammation, provoking pyospermia, can be caused by various factors:
- varicocele ;
- infectious agents: chlamydia, ureoplasma, gardnerella, causative agent of gonorrhea and other STDs, tuberculosis;
- toxic effects: smoking, alcohol, drugs, occupational hazards, use of chemical intravaginal contraceptives by the partner;
- therapy with clomiphene (estrogen antagonist, in men it is used for azoospermia , oligozoospermia, androgen deficiency) - pyospermia occurs on average in 14% of patients;
- plastic urethra;
- HIV in immunodeficiency stage;
- urethral strictures;
- foreign bodies;
- urolithiasis disease.
In cases where the infectious agent is not detected, it is considered to be a subclinical infection.
Pathology development mechanism
To fight infection, leukocytes secrete so-called reactive oxygen species (ROS) - peroxides and free radicals, which have an aggressive cytotoxic (killing cells) action. RFK damage the cell membranes of spermatozoa, which consist mainly of phospholipids and polyunsaturated fatty acids . There is a so-called oxidative stress: chemical reactions of lipid peroxidation develop (approximately the same reactions occur under intense radiation exposure). The properties of the phospholipids that make up the cell wall change: the cell membrane becomes permeable to RFK. Having penetrated inside the cell, reactive forms of oxygen damage the mitochondria, which produce energy for the cells. Deprived of energy, the sperm cell loses its motility, and its viability decreases .