Pus in Semen   

Pus cells in semen may be due to infection into genito-urinary tract due to any of the following causes:

1.) Chlamydia infection

Chlamydia is a  common infection of genitourinary tract all over world. It’s a bacterial infection. The infection with bacteria decreases sperm count motility & fertilizing capacity of sperms. Complication of this can be epididymitis, and inflammation in the scrotum that may leave the man sterile.

2) Gonorrhea (Gonococcal Urethritis)

It is caused by the bacterium Nesseria gonorrhoea.
Symptoms include pus in semen. The infection with bacteria decreases sperm count motility & fertilizing capacity of sperms. Complication of this can be epididymitis, and inflammation in the scrotum that may leave the man sterile.

3) Non-Specific urethritis or NSU (Non-gonococcal Urethritis):  It is caused by any of the following causative agent Chlamydia trachomatis, Ureaplasma urelyticum, Mycoplasma genitalium ,Candioda species, Anaerobes, Trichomonas vaginalis,, Unidentified / idiopathic. Some times it may be Persistent/recurrent non-gonococcal urethritis or Prolonged urethritis.

4) Candidal Balanitis (Thrush) is a fungal infection.

5) Prostatitis( Acute or Chronic)

Diagnostic tests
Urine may show threads or ‘beads of pus’ positive leycocyte esterase test.
Gram Stain
Culture
Molecular identification
Methelyne blue stain
Antigen detection techniques
Poly merase chain reaction
Trichomonas vaginalis
Fungi detection test
Herpes simplex virus antibodies
 

TREATMENT :
Spectinomycin
Ceftriaxone
Co-trimoxazole
Doxycycline 100 mg
Amoxoxycillin
Ceftriaxone
Erythromycin
Azithromycin
Doxycycline
Ofloxacin
Penicillin
Doxycycline
Minocycline
Flurouracil

Anti-Sperm Antibody

In some male’s, antibody production starts against its own sperms. These antisperm antibodies may then enter the testis & seminal fluid and ‘attack’ the sperms & sperm forming cells. These antisperm antibodies stick the sperms with each other and thus tend to seriously reduce sperm motility, thereby causing infertility. By the use of various treatments, the amount of antibodies may be reduced and fertility restored.

Antisperm antibodies have been found to be present in up to 40% of couples with unexplained infertility, and in 10% of unexplained male infertility. Infertility in a couple can occur if the woman’s cervical mucus provides a hostile environment by producing antibodies to her partner’s sperm. More often, the problem is due to the male partner producing antibodies against his own sperm. Unilateral or bilateral obstruction of the genital tract (either congenital or acquired), epididymitis and varicocele are also sometimes associated with an autoimmune response against spermatozoa. 

What are Antisperm Antibodies?
Antisperm antibodies are one immune factor which could be involved in infertility. Antisperm antibodies are cells that fight against normal, healthy sperm. If you have antisperm antibodies, instead of seeing sperm as natural cells, your immune system fights against your sperm and destroys them. This prevents you from producing any viable sperm. Though still to be proven, there is evidence that antibodies against sperm can result in male infertility.

How Do Antisperm Antibodies Affect Fertility?
Antisperm antibodies can really impair the function of healthy sperm. These antibodies attach to your sperm, reducing motility and making it more difficult for sperm to pass through cervical mucus. Antisperm antibodies can also force sperm to clump together, making it difficult for your sperm to fertilize an egg.

Testing for Antisperm Antibodies
There are a variety of tests that can detect the presence of antisperm antibodies in the body:

• Blood Tests: In women, blood tests are commonly used to detect the antibody.
• Post-Coital Test: The post-coital test can detect the presence of antisperm antibodies in a woman's cervical mucus.
• Sperm Testing: In men, sperm testing is the best way to analyze for antisperm antibodies. The immunobead assay and the mixed agglutination reaction test are both used.

Treating Antisperm Antibodies?
There are a variety of treatments available to help couples struggling with antisperm antibodies to conceive.

• Corticosteroids: Corticosteroids help to decrease the production of antisperm antibodies. Unfortunately, corticosteroids are associated with side effects, including hipbone damage.
• Intrauterine Insemination(IUI): IUI can help couples to overcome antisperm antibodies as it allows sperm to bypass the cervical mucus. Fertility drugs can also be used.
• In-Vitro Fertilization(IVF): IVF is the most successful treatment for couples with antisperm antibodies. This allows the sperm to be directly injected into the egg, without havng to travel throguh the uterus and fallopian tubes.

Less Semen Formation 

Low Semen Levels

A reduced amount of ejaculated semen (less than 0.5 milliliters per sample) may be caused by a

1) Obstruction in the tube carrying the sperm from testis to outside i.e. structural abnormality in the tubes transporting the sperm.

2) Retrograde ejaculation: In which patient gets orgasm at normal time but semen in place of coming out through penile opening goes into bladder. 

(3) Absent Ejaculation or Orgasm: There are certain conditions in which patient does not get orgasm even after prolonged sexual activity. the cause of this can be primary, Psychogenic or due to certain medication, neurological diseases, surgeries etc. Treatment needs diagnosis of cause & then treatment.

4)  Hormone deficiency of pituitary gland as L.H., F.S.H., Prolactin, thyroids hormone, hypothalmic deficiency of GnRH, Pituitary gland failure, Hypopituitarism, Idiopathic hypopituitarism, Kallman syndrome, Isolated hypogonadotropic hypogonadism, Drugs, toxins, Idiopathic hypogonadotropic hypogonadism & due to many more causes.

5) Testicular disorders (primary leydig cell dysfunction), Chromosomal (Klinefelter syndrome and variants, XX male gonadal dysgenesis), Defects in androgen biosynthesis, Orchitis (mumps, HIV, other viral, ),Myotonia dystrophica, Toxins (alcohol, opiates, fungicides, insecticides, heavy metals, cotton seed oil), Drugs (cytotoxic drugs, ketoconazole, cimetidine, spironolactone)

 Absent Ejaculation

Absent Ejaculation Orgasm

Absent ejaculation in which patient does not gets orgasm & semen discharge even after prolong sexual activity 

3. Delayed ejaculation: In this disorder orgasm & semen discharge occurs after abnormally prolonged sexual activity. 

4. Retrograde ejaculation: In which patient gets orgasm at normal time but semen in place of coming out through penile opening goes into bladder. 

(4) Absent Ejaculation or Orgasm: There are certain conditions in which patient does not get orgasm even after prolonged sexual activity. the cause of this can be primary, Psychogenic or due to certain medication, neurological diseases, surgeries etc. Treatment needs diagnosis of cause & then treatment.

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