What do pus cells in the semen mean ?

Infectious diseases were common in India in the past. Smallpox, for instance, used to result in azoospermia and this infection injured the epididymis, leading to ductal obstruction. Tuberculosis can also affect the epididymis, causing azoospermia. Gonorrhea, chlamydia and syphilis, along with other STDs (sexually transmitted diseases), are also capable of damaging the man's genital system, resulting in irreparable injury. Mumps is another viral disease which could cause inflammation of the testis - particularly when young men are afflicted with it. This could even result in testicular failure if it damages both testes.

The presence of white blood cells (WBCs) during semen analysis often causes concern to infertile couples , and even their doctors. This condition, known as pyospermia or leucocytospermia occurs commonly,  but the mere presence of white pus cells in the semen is not sufficient to make a diagnosis of an genital tract infection. Many laboratories  make an error in reporting because they do not have the expertise to differentiate between pus cells and sperm precursor cells. Erroneous reports by such labs may result in the doctor resorting to antibiotic treatment which just wastes the patient’s time and money, because these are normal and will persist!

Even the semen culture report can be very misleading. It’s common for the lab to grow bacteria such as E coli when they culture the semen. These are actually commensals which are found normally on the skin, even in fertile men. However, this is often mistaken for a pathogenic organism by unsophisticated doctors who will try to “treat” this with antibiotics !

The question a patient needs to ask is - Can these bacteria actually cause male infertility? Can fertility be improved by treating such infections? In my opinion, treating most of these "abnormal reports" does not help to improve the man's fertility at all.

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