Correlation of leukocytospermia with clinical infection and the positive effect of antiinflammatory treatment on semen quality Jakob E. Lackner, M.D., Ralf Herwig, M.D., Jörg Schmidbauer, M.D., Georg Schatzl, M.D., Christian Kratzik, M.D., and Michael Marberger, M.D. Department of Urology, Medical University of Vienna, Austria Objective: To investigate the correlation between leukocytospermia, bacteriospermia, and clinical signs of infection and to evaluate antiinflammatory therapy. Design: Prospective nonrandomized study. Setting: Andrologic clinic at university hospital. Patient(s): A total of 56 patients were evaluated, and 12 of them received further treatment with a Cox-2 inhibitor. Intervention(s): Semen analysis and clinical investigation were done according to World Health Organization guidelines. Serum levels of leukocytes, C-reactive protein (CRP), and prostate-specific antigen (PSA) were measured from blood samples. Main Outcome Measure(s): Sperm concentration, leukocyte concentration, serum leukocyte count, CRP, PSA, bacterial growth. Result(s): Leukocytospermia (1  10 6 /mL) was present in 60.7% of the semen samples, significant pathogenic bacterial growth was detectable in 35.7%, and 14.3% of the samples fulfilled the criteria for ejaculate signs of infection. All serum parameters were within the normal range. In abacterial leukocytospermia, treatment with a Cox-2 inhibitor decreased leukocytospermia from 5.5  10 6 /mL to 1.0  10 6 /mL (P=.001) and increased sperm concentration from 22.5  10 6 /mL to 48.0  10 6 /mL (P=.02). Conclusion(s): There was no evidence of an immune response in the peripheral blood system. In abacterial leukocytospermia, treatment with a Cox-2 inhibitor seems to be able to reduce leukocytospermia and increase sperm count. (Fertil Steril 2006;86:601–5. ©2006 by American Society for Reproductive Medicine.) Key Words: Leukocytospermia, bacteriospermia, clinical signs of infection, antiinflammatory therapy, Cox-2 inhibitor Bacteriospermia is commonly found in semen samples from infertile men, even in the absence of a clinically apparent male accessory gland infection (1–3). To reduce contamina- tion, the World Health Organization (WHO) recommends hygienic preparation before delivering the semen sample (e.g., urination and washing the hands, penis, and scrotum) (4). Despite special procedures carried out before ejacula- tion, bacteria are only reduced in number and not eliminated. Enteric contaminants in particular may be reduced using antibacterial skin preparation (5). Leukocytes are also commonly found in semen samples, and a level above 1  10 6 /mL is considered pathologic according to WHO criteria (6). Whether a correlation exists between leukocytospermia and bacteriospermia remains controversial, particularly in asymptomatic men (7–10), and the presence of seminal bacteria may represent only contam- ination (11). Male accessory gland infection is said to be present by WHO if specific symptoms, e.g., urinary tract infec- tion, epididymitis, sexually transmitted disease, thickened or tender epididymis or vas deferens, or abnormal digital rectal examination, or ejaculate signs, e.g., leukocytospermia or bac- teriospermia, are present (4). Infection is diagnosed if two signs of each group or both ejaculate signs are present. Reports in the literature about treatment of leukocytosper- mia with an antiinflammatory medication are rare (12), al- though antioxidant treatment with carnitines or therapies with antihistamine-like drugs have recently been published (13, 14). Treatment of leukocytospermia might improve se- men quality, as suggested by results from recently published work showing a negative effect of leukocytes and reactive oxygen species, which might be produced primary by leu- kocytes, on semen quality (15–20). One aim was to investigate a possible correlation between ejaculate and clinical signs of infection, bacterial growth in semen samples, and inflammatory signs in systemic blood. If bacteria are merely contaminants, no signs of clinical inflammation should be detectable. The second aim was to evaluate whether in the case that there is no correlation between bacteriospermia, leukocytospermia, and infection signs, an antiinflammatory prostaglandin inhibitory ther- apy with cyclooxygenase-2 (Cox-2) inhibitor can influ- ence semen quality. Received November 8, 2005; revised and accepted January 27, 2006. Reprint requests: Jakob E. Lackner, M.D., Department of Urology, Med- ical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria (FAX: +4314089966; E-mail: jakob.lackner@meduniwien.ac.at). 601 0015-0282/06/$32.00 Fertility and Sterility Vol. 86, No. 3, September 2006 doi:10.1016/j.fertnstert.2006.01.032 Copyright ©2006 American Society for Reproductive Medicine, Published by Elsevier Inc.