Leukocytospermia or Pyospermia – Symptoms, Causes & Treatment

Leukocytes or white blood cells (WBCs) are present in the semen by default, though in a reduced number. If an elevated number of WBCs appears after a semen analysis (SA), we may suspect that there exists an infection. The presence of a high number of leukocytes in the semen is an abnormality known as leukospermia or pyospermia.

The various sections of this article are assembled in the following table of contents.

Definition

Leukospermia, leukocytospermia, or pyospermia is defined as the presence of more than 1 million leukocytes in 1 ml semen. As stated earlier, having Leukospermia means that there is an abnormal increased amount of leukocytes in the ejaculate.

Leukocytes, leucocytes, or white blood cells (WBCs) are cells produced by the immune system that can be found in the blood. Their main function is to help your body fight infections.

While it is normal to detect a few WBCs in the semen after performing a sperm analysis, an elevated concentration of leukocytes in a sample can compromise male fertility, as it increases the levels of oxidative stress and decreases sperm quality. In short, in can reduce a man’s sperm concentration.

The presence of leukocytes in the semen can cause temporary sterility, but rarely permanent sterility or infertility. For this reason, when leukospermia is detected, the patient needs a specific treatment to solve the infertility issues it might be causing and avoid that it becomes permanent.

Specialists calculate the amount of leukocytes in the semen per milliliter of semen following the criteria of the World Health Organization (WHO), which reference value is set at 1 million leukocytes per ml of semen. If a sample surpasses this figure, the patient will be diagnosed with pyospermia or leukospermia.

The picture above shows how a semen sample with leukocytospermia would look under the microscope. Leukocytes differ from spermatozoa because they are round-shaped structures and larger in size.

Symptoms and effects

Normally, leukospermia is asymptomatic and can only detected via a sperm analysis, often when the patient is getting started with a fertility treatment or applies to become a sperm donor.

However, sometimes the patient has certain signs and symptoms that may indicate the presence of pyospermia, including:

  • Semen appears yellow in color
  • Swelling in the area of the penis or groin
  • Genital infections: herpes, chlamydia, gonorrhea…
  • Widened or dilated veins coming from the testes
  • Infrequent ejaculation
  • Reduced fertility

Inflammations often cause the formation of a large amount of active-oxygen radicals, which can have negative effects on sperm, including the disruption of the integrity of their membranes, and the inhibition of sperm motility.

Causes of leukospermia

The main causes of leukospermia are infections or inflammations of the urethra, and prostatitis or inflammation of the prostate gland.

More often than not, this kind of infections come with no symptoms and are detected after performing a semen analysis, when a man is about to start an infertility treatment or being screened to become a sperm donor.

There exist other causes that can lead to an increased level of leukocytes in the semen. Various studies have revealed that sexual abstinence can have an influence, as the more time sperms remain in the epididymis, the greater the amount of macrophages and granulocytes that will be attracted by older sperm, which can cause an elevated level of leukocytes in the ejaculate.

As for men with a vasectomy, there is proof that men who have undergone this surgical intervention have a lower amount of leukocytes in their semen if compared to men who have not had a vasectomy done.

Learn more about this permanent sterilization method here: Process, pros and cons of a vasectomy.

On the other hand, men who have undergone a vasovasostomy or vasectomy reversal tend to present altered sperm parameters in the results of their semen analysis, as well as sperm dysfunction, mainly caused by high levels of Reactive Oxygen Species (ROS). There is direct link between an increase in the ROS levels and the presence of WBCs in the semen. This is not an absolute association, though.

Genital tract infection

Genital tract infections represent about 4 to 10% of the cases of male sterility. Inflammation causes leukocytes to infiltrate in the seminal fluid, which diminishes sperm motility, triggers acrosome reaction, and reduces the fertilization potential of sperms. All this makes it more difficult for the couple to achieve pregnancy.

Approximately 50% of leukocytes that infiltrate in the seminal fluid come from the prostate and the seminal vesicles where the man suffers from prostatitis (prostate infection) or seminal vesiculitis (seminal vesicle infection). Thus, infections in the accessory glands lead to an increased number of leukocytes in the ejaculate.

The following is a list of the most common microorganisms that can cause it:

  • Escherichia coli or E. coli
  • Klebsiella pneumonia
  • Ureaplasma urealyticum
  • Proteus mirabilis
  • Pseudomona aeruginosa
  • Staphilococcus aureus
  • Mycoplasma hominis
  • Enterococcus faecalis
  • Morganella morganii
  • Chlamydia trachomatis, and other sexually transmitted diseases (STDs).

Sperm agglutination in patients with pyospermia can very strongly indicate the presence of an E. coli infection.

Bacteria and other germs can nest in any organ of the seminal tract, thereby causing the gonads, seminal ducts, and accessory glands to become swollen. Depending on the location of the infection, it will lead to:

Orchitis
infection of the testicles.
Epididymitis
infection of the epididymis.
Orchiepididymitis
infections of both the testicles and the epididymis.

Semen culture

When the amount of leukocytes in the semen is above 1 million/ml after a semen analysis, a bacteriological workup that involves semen culture is required.

Samples are incubated at the adequate temperature in each culture medium. Then, the specialist evaluates the results of the semen culture, that is, whether any of the microorganisms analyzed is present.

If the result is positive, the next step is to examine the plate, and count the number of colonies. One should note that the color of a colony is an indicator of the microorganisms that form it.

Additionally, sperm staining techniques and subsequent observation under the microscope can also help the specialist to determine what is causing the infection.

The result of the semen culture should be null, as bacteria, yeast, or any other microorganism that causes infections should not be present.

Undergoing a semen culture is also recommended in men who experience any of the symptoms listed above, including pain and inflammation of the testicles, blood in the sperm (hematospermia), or changes in the color and/or odor of the ejaculate.

The presence of blood in the seminal fluid can be caused by the rupture of a small blood vessel at some point throughout the pathway of sperm, generally as a consequence of an urinary infection or trauma.

Treatment

If some sort of microorganism is detected, the specialist will prescribe a treatment to erradicate the infection. Normally, the medicine of choice are antibiotics.

The type of antibiotics used and the duration of the treatment depend on the pathogen identified through the semen culture as the cause of the infection.

Aside from antibiotics, sometimes doctors prescribe painkillers or antioxidants that help diminish the levels of oxidative stress caused by the infection. This is also the treatment of choice when discovering the pathogen behind the infection has not been possible (i.e. abacterial leukocytospermia).

After the treatment, the patient should undergo another spermatobioscopy to count the number of leukocytes again. If antibiotics have worked, the amount of leukocytes in the semen would be lower. In general, if the infection is cured, all other sperm parameters improve as well, thereby boosting sperm quality.

FAQs from users

Is there a cure for leukocytospermia?

Yes. In most cases, it is possible to erradicate it by means of antibiotics. The type of antibiotics to administer is dependent on the pathogen causing the infection.

When there is no infection, and the only symptom is an inflammation, painkillers may be enough.

Can leukocytospermia cause male infertility?

Leukocytospermia is a cause of male factor infertility, but in principle there is no reason why it should lead to long-term male sterility. As explained above, in most cases, it can be treated with antibiotics and normally patients are able to recover or even improve their sperm parameters.

Yes. Several studies have found a link between leukospermia and greater chances of suffering teratospermia, that is, having an elevated number of morphologically abnormal sperm in the ejaculate.

However, this association is not clear enough yet, as it does not apply in all cases—the amount of sperms with abnormal forms does not always increase, or not so severely as to diagnose the patient with teratozoospermia.

Also, pyospermia has been related to low sperm concentration (oligospermia) as well as alterations in sperm motility (asthenospermia).

Suggested for you

As you have just read, leukospermia can be detected by means of a semen analysis or seminogram. If you want to learn more about this diagnostic test, visit this post: What is a semen analysis and what does it involve?

Moreover, if you want to delve deeper into the causes of this pathology, we recommend you to have a look at this article: Infections and temporary sterility.

19 comments

  1. usuario
    Chuck L.

    Hello, unfortunately I can say I’m an expert on this topic. After several years trying to conceive unsuccessfully, I decided to resort to an specialist. My doctor advised me to perform a seminogram, so that’s what I did. And the result was that I had more than 10 million leukocytes in semen and that was our problem. Luckily I followed an antibiotic-based treatment and the improvement was considerable. We did an artificial insemination and finally got pregnant. So my conclusion is: it’s very important to have these kind of health issues controlled! Thanks for letting me participate.

  2. usuario
    Ehsan

    Volume 3.5 mL
    Color Grey
    PH 8.0
    Liquefaction Time 30 Min

    Motility (%) 65-70

    Progress Motility 3+
    Spermatozoa Count 200 x10^6/L
    Spermatozoa vitality (%) 80
    Morphology-Abnormal 25

    RBC /hpf 6-8
    WBC /hpf 15-20
    Crystals are Nil

    Clumping is 3+

    Normal functional Sperm x10^6/L is 365

    • avatar
      Sandra F.Fertility counselor

      Hello Ehsan,

      Volume is ok. As regards motility, it is kind of difficult for me to provide an answer, as I don’t know which type of motility is being measured here. However, it seems to be fine in principle. Concentration and vitality are ok, too.

      Given that your WBC are above 2-5, it indicates the presence of an infection on your semen. Red blood cells are also above the normal values, which indicates the presence of some blood traces on your sample as well. Sperm agglutination is also present.

      If the infection is confirmed by your doctor, you’d be prescribed antibiotics and advised to repeat the semen analysis.

      Hope this helps,

      Regards

  3. usuario
    prashun

    My semen report says I have leukocytes 10 to 12/HPF (High Power Field) noted and absence of spermatozoa… Pls help, what treatment to take and which doctor to consult.

    • avatar
      Sandra F.Fertility counselor

      Dear prashun,

      First of all, the doctor you should consult is an andrologist ideally. Secondly, I’m afraid in principle there is no treatment to take or follow. With azoospermia, patients should go for a second semen analysis to confirm the diagnosis. If so, the next step would be to find what is causing it by means of a testicular biopsy if you want to find out whether you’ll be able to conceive in the future. If nothing is found through a biopsy, I’m afraid it is a case of secretory azoospermia, and there’s nothing to be done. Conversely, if sperm are found, it is obstructive azoospermia and you might still have chances with ICSI.

      I hope this helps,

      Best

      • usuario
        Mugarisha

        I did a sperm analysis and the results were as follows:
        Volume – about 1 ml
        Viscosity- Normal viscous
        Motility- about 50 % progressive forward – about 15 % sluggish movement – about 35 % dead

        Count – < 20 millions/ umm
        Leucocytes – 30 – 50 hpf

        Please can you help to analyse the information and give me some prescriptions?

  4. usuario
    Tony

    Hello, the result of my semen analysis reads:

    Appearance: greyish-white & non viscous fluids

    volume: 2.5ml
    motility: 2% sluggishly motile

    cell count: 900,000 cells/ml

    morphology: few normal cells seen

    leukocytes: numerous

    culture: yielded scanty growth of staphylococcus Aureus

    please kindly help me to explain the result, can I father children under such conditions? if there’s any problem kindly mention it with possible solutions.
    I need your urgent reply. Thanks

    • avatar
      Andrea A.Assisted Reproduction Specialist

      Dear Tony,
      Your semen analysis shows several seminal alterations that affect your possibilities of conceiving naturally. Motility, concentration and morphology are strongly altered with values way lower than the ones that are considered normal and that allow natural pregnancy. The recommendation is to consult an assisted reproduction specialist in order to determine which would be the best treatment and technique in your case.

      On the other hand, on the culture has been detected an infection that may need antibiotic treatment. The appropriate antibiotic will be prescribed by your doctor.

      I hope I have been able to help.
      Best regards,

  5. usuario
    Sophie Mendham

    Can anybody help? My doctor is now on leave and the private clinic want another £100 to tell me what these results actually mean!

    Volume ml – 2.40
    pH – 7.50
    Appearance – Clear
    Viscosity – Normal
    Liquefaction – Complete
    Density x106 /ml – 44.00
    Total count x106 – 105.60
    Motility %
    Progressive – 72.0
    Non progressive – 1.0
    Immotile – 17.0
    Normal forms % – 4.00

    Other Parameters
    Agglutination – Nil
    Aggregation – Nil
    Round Cells (x106 /ml) – >5.0×10/6/ml

    Conclusions:
    Normozoospermia. All parameters above the lower reference limits, therefore this sample is suitable for any form of treatment.
    High density round cells
    Increased round cells please discuss with the clinicians. Please call the contact centre on —– to book a follow-up appointment with the clinical team.

    • avatar
      Sandra F.Fertility counselor

      Dear Sophie,

      As the conclusions of this analysis indicate, your partner is normozoospermic, which means his semen results are within the normal results and in principle there should be no problem to achieve a pregnancy naturally.

  6. usuario
    Sami hak

    Hello,
    The semen analysis:
    Volume: 2
    pH: 9
    Count: 45 million / ml
    Ejaculate: 90 million / ml
    Motility: 45%
    White cells: 2
    Motility 80%

  7. usuario
    Attah

    Please I did a semen analysis and the result was normal after about 6 months, when I did another one and the outcome was:

    Volume ml – 4.20
    pH – 7.50
    Appearance – Clear
    Viscosity – Normal
    Liquefaction – Complete
    Total count x106 – 29.60
    conc. 7m/mil
    Motility 11%
    Progressive – 15%
    Other Parameters
    Agglutination – Nil
    Aggregation – Nil
    WBC-ABNORM.

    Pls what’s the problem? And I have bin TTC for 15 months now, I was prescribed antibiotics for the infection. How long after the treatment should I re-test? Thank You.

  8. usuario
    Kallu

    What if wbc count is 2.50? If this is a real concern??
    Total volume: 3 ml
    Sperm concentration: 28 mill per ml
    Active: 20
    Mod active: 20
    Sluggish:30
    Dead:30
    Normal morphology:80%
    Abnormal morphology:20%
    Wbc:2.50
    Rbc: 0.4
    Madam please give your feedback! Thanks

    • avatar
      Sandra F.Fertility counselor

      Dear Kally,

      What unit of measure have they used for measuring WBC in this semen analysis? And what are the reference values used? I can’t give you an answer without that.

  9. usuario
    Roxy

    I need help please, I would like to know if the results are normal.

    COLOR. White grey
    PH: 8.0
    VOLUME:6.0ml
    LIQUEFACTION: 15min.
    LEUCOCYTES: 0.2-0.3 /ml
    SPERM COUNT: 70 000 000/ML
    NORMAL: 70%
    ABNORMAL:30%

    0 HOURS
    MOTILITY:65%
    VITALITY:70%

    1 HOUR
    MOTILITY: 60%
    VITALITY : 65%

    2 HOURS
    MOTILITY:55%
    VITALITY:60%

    • avatar
      Andrea A.Assisted Reproduction Specialist

      Dear Roxy,
      All the parameters seem to be within the normal range. Anyway, the doctor that requested the analysis should take a look in order to check that everything is alright taking into account the reference values used by the lab.
      I hope I have been able to help.

  10. usuario
    Rizwan Jalal

    Please comment

    CHARACTERISTICS OF EJACULATE
    —————————-
    ABSTINANCE 3 days 3 – 7
    COMPLETENESS Yes
    APPEARANCE Grey-white
    VOLUME 3.7 ml 1.5 – 6.0
    LIQUIFACTION Complete
    S-VISCOSITY 15.0
    TOTAL SPERM COUNT 447.7 Million > 39
    ROUND CELLS 1.6 mill/ml H < 1.0
    LEUCOCYTES 1.3 mill/ml H 40
    FORWARD PROGRESS 2 (Moderate)
    MOTILITY INDEX 408 240 – 1000
    MORPHOLOGY
    ———-
    NORMAL FORMS 6 % > 4

    COMMENT
    Normospermic ejaculate.
    PR:PROGRESSIVE 80 % > 32
    NP: NON-PROGRESSIVE 7 %
    IM: IMMOTILE 13 %

  11. usuario
    Beth

    Volume 4.5 ml
    pH 7.6
    Sperm Concentration 13 million ml
    Progressive Motility 54%
    Total Motility 54%
    Total Sperm Concentration 58.5 million
    Round Cell > 1 million
    WBC > 1 Million

    Normal Spermatozoa 4%
    Spermatozoa with head defects 89%
    Spermatozoa with Midpiece defects 6%
    Spermatozoa with Tail Defects 1%

    Once we clear up the WBC, does it seem like we’ll have good odds of getting pregnant? Seeing urologist Wednesday but anxious for answers.

    • avatar
      Sandra F.Fertility counselor

      Hello Beth,

      After evaluating this semen analysis, I see that this is a case of mild oligospermia. However, as the volume is right, the total amount of sperms is right. As for WBC, yes, once the infection is cured, it is likely that the sperm concentration improves, so you can have chances of getting pregnant.

      I hope this helps,

      Best

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