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Pus in Semen – Taseer Dawakhana
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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. Chlamydia is the most common diagnosed STI and the number of new cases keeps rising. Young men and women aged 16 to 24 are most at risk although people of all ages can be affected.

Chlamydia is a sexually transmitted infection caused by a bacterium.

Chlamydia can be transmitted through oral and anal sex. It’s such a widespread disease that it is often known as the silent epidemic.

Chlamydia is the most commonly reported infectious disease and although curable is considered one of the most dangerous sexually transmitted diseases among men because of the far-reaching complications it can cause.

The reason chlamydia is so widespread and dangerous is because it often goes unrecognised and therefore is left untreated. Around 50% of men with chlamydia have no symptoms of the disease once infected. If left untreated it can cause infertility.

It is for this reason that regular testing is encouraged among sexually active men, particularly those under the age of 24. Statistics show that the most vulnerable and highest reported number of cases are men between the ages of 16 and 24.

Who is at risk?

Everyone who is sexually active, or who have been sexually active but has not been screened for chlamydia. Also, if you’ve had multiple sexual partners and fail to use contraception (condoms and dams) 100% of the time.

Chlamydia Prevention

You can get and spread chlamydia through unprotected oral and anal sex. This means you should approach sexual relationships or encounters responsibly, limit the number of sex partners, always use condoms or dams, and if you think you are or may be infected, avoid any sexual contact until you have been given the all-clear by your doctor or local GU/STI clinic. You also need to make sure your partner is treated to avoid the risk of re-infection.

Where can Chlamydia develop?

Chlamydia in men can initially develop in several areas of the body:

  • Urethra
  • Throat
  • Mouth
  • Rectum

Chlamydia Symptoms

Not everyone will experience every symptom outlined below, but some of you may experience one or more of the following (symptoms of chlamydia in men):

  • Pain, burning or stinging during urination
  • Pain or tenderness in the testicles
  • Clear, or slightly coloured discharge from the urethra
  • Unusual itching, particularly around the opening of the end of the penis
  • Low grade fever

In rare instances, chlamydia can infect the area in and around the rectum, producing inflammation and the production of a clear, sticky discharge from the rectum and, through not always, pain when going to the toilet.

Complications of Chlamydia infections in men

  • Sterility
  • Fertility problems
  • Epididymitis this is inflammation of the epididymis, the tube that carries sperm from the testicle. It can occur in one or both tubes and can result in extensive, very painful swelling
  • Reiter’s Syndrome, an autoimmune condition where the joints are affected by arthritis

Chlamydia Test

It is a very straightforward test which can be carried out either by your GP or at a GU/STI clinic. A swab from the urethra or throat should be sufficient to identify whether you are infected or a simple urine sample.

  1. Gonorrhea (Gonococcal Urethritis)

Also called the “clap” or “drip,” gonorrhea is a contagious disease transmitted most often through sexual contact with an infected person. Gonorrhea may also be spread by contact with infected bodily fluids, so that a mother could pass on the infection to her newborn during childbirth. Both men and women can get gonorrhea. The infection is easily spread and occurs most often in people who have many sex partners.

What Causes Gonorrhea?

Gonorrhea is caused by Neisseria gonorrhoeae, a bacterium that can grow and multiply easily in mucus membranes of the body. Gonorrhea bacteria can grow in the warm, moist areas of the reproductive tract, including the cervix (opening to the womb), uterus (womb) and fallopian tubes (egg canals) in women, and in the urethra (the tube that carries urine from the bladder to outside the body) in women and men. The bacteria can also grow in the mouth, throat, and anus.

How Common Is Gonorrhea?

Gonorrhea is a very common infectious disease. In the U.S. each year, about 700,000 people are infected with gonorrhea, and about 75% of all reported gonorrhea is found in younger persons aged 15 to 29. The highest rates of infection are usually found in 15- to 19-year-old women and 20- to 24-year-old men.

How Do I Know If I Have Gonorrhea?

Not all people infected with gonorrhea have symptoms, so knowing when to seek treatment can be tricky. When symptoms do occur, they are often within 2-10 days after exposure, but can take up to 30 days and include the following:

Gonorrhea Symptoms in Women

  • Greenish yellow or whitish discharge from the vagina
  • Lower abdominal or pelvic pain
  • Burning when urinating
  • Conjunctivitis (red, itchy eyes)
  • Bleeding between periods
  • Spotting after intercourse
  • Swelling of the vulva (vulvitis)
  • Burning in the throat (due to oral sex)
  • Swollen glands in the throat (due to oral sex)

In some women symptoms are so mild that they escape unnoticed.

Many women with gonorrhea discharge think they have a yeast infection and self-treat with yeast infection medications purchased over-the-counter. Because vaginal discharge can be a sign of a number of different problems, it is best to always seek the advice of a doctor to ensure proper diagnosis and treatment.

Gonorrhea Symptoms in Men

  • Greenish yellow or whitish discharge from the penis
  • Burning when urinating
  • Burning in the throat (due to oral sex)
  • Painful or swollen testicles
  • Swollen glands in the throat (due to oral sex)

In men, symptoms usually appear 2-14 days after infection

How Is Gonorrhea Diagnosed?

Your doctor will use a swab to take a sample of fluid from the urethra in men or from the cervix in women. The specimen will then be sent to a laboratory to be analyzed. You also may be given a throat or anal culture to see if the infection is in your throat or anus. There are other tests which check a urine sample for the presence of the bacteria. You may need to wait for several days for your tests to come back from the lab.

Gonorrhea and chlamydia, another common sexually transmitted disease, often occur together, so you may be tested and treated for both.

How Is Gonorrhea Treated?

To cure the infection, your doctor will give you either an oral or injectable antibiotic. Your partner should also be treated at the same time to prevent reinfection and further spread of the disease.

It is important to take all of your antibiotics even if you feel better. Also, never take someone else’s medication to treat your illness. By doing so, you may make the infection more difficult to treat. In addition,

  • Tell anyone you have had sex with recently that you are infected. This is important because gonorrhea may have no symptoms. Women, especially, may not have symptoms and may not seek testing or treatment unless alerted by their sex partners.
  • Don’t have sex until you have completed taking all of your medicine.
  • Always use condoms when having sex.

What Happens If I Don’t Get My Gonorrhea Treated?

Untreated gonorrhea can cause serious and permanent problems in both women and men.

In women, if left untreated, the infection can cause pelvic inflammatory disease, which may damage the fallopian tubes (the tubes connecting the ovaries to the uterus) or even lead to infertility, and untreated gonorrhea infection could increase the risk of ectopic pregnancy (when the fertilized egg implants and develops outside the uterus), a dangerous condition for both the mother and baby.

In men, gonorrhea can cause epididymitis, a painful condition of the testicles that can sometimes lead to infertility if left untreated. Without prompt treatment, gonorrhea can also affect the prostate and can lead to scarring inside the urethra, making urination difficult.

Gonorrhea can spread to the blood or joints. This condition can be life-threatening. Also, people with gonorrhea can more easily contract HIV, the virus that causes AIDS. People with HIV infection and gonorrhea are more likely than people with HIV infection alone to transmit HIV to someone else.

How Does Gonorrhea Affect Pregnancy and Childbirth?

Gonorrhea in a pregnant woman can cause premature delivery or spontaneous abortion. The infected mother may give the infection to her infant as the baby passes through the birth canal during delivery. This can cause blindness, joint infection, or a life-threatening blood infection in the baby. Treatment of gonorrhea as soon as it is detected in pregnant women will lessen the risk of these complications. Pregnant women should consult a doctor for appropriate medications.

How Can I Prevent Infection?

To reduce your risk of infection:

  • Use condoms correctly every time you have sex.
  • Limit the number of sex partners, and do not go back and forth between partners.
  • Practice sexual abstinence, or limit sexual contact to one uninfected partner.
  • If you think you are infected, avoid sexual contact and see a doctor.

Any genital symptoms such as discharge or burning during urination or an unusual sore or rash should be a signal to stop having sex and to consult a doctor immediately. If you are told you have gonorrhea or any other STD and receive treatment, you should notify all of your recent sex partners so that they can see a doctor and be treated.

  1. 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

What is NGU?

Nongonococcal urethritis (NGU) is sometimes called nonspecific urethritis (NSU). It is an infection of the urethra (the tube leading from the urinary bladder to outside the body). The symptoms of NGU are similar to gonorrhea, but the usual treatments for gonorrhea will not work.

What causes NGU?

NGU is caused by a bacterium called Chlamydia trachomatis. There are several other bacteria—including Ureaplasma urealyticum, Mycoplasma and Trichomonas—that can cause symptoms resembling those of NGU.

How does NGU spread?

NGU is a sexually transmitted disease (STD). It is passed from one person to another by unprotected sexual contact. It can be spread through vaginal sex, oral sex or anal sex.

What are the symptoms of NGU?

It usually takes one to three weeks after the infection occurs before a man develops any symptoms of NGU. The first symptom is usually a leakage of milky fluid (discharge) from the tip of the penis. The amount of discharge may vary from a little to quite a lot. There also may be mild burning of the penis during urination. If the symptoms are ignored, the discharge may decrease although the infection is still present. Sometimes there are no symptoms. If left untreated, the infection may move up around the testicles, causing pain, swelling and sterility. The infection also may spread to other parts of the body, causing severe illness.

How can I know if I have NGU?

If you think you have NGU, or any STD, contact your health care provider. He or she will examine you and perform tests, if necessary, to determine if you have an STD. A sample of fluid is taken from the penis and tested for the germs that cause gonorrhea and chlamydia. Notably, 20% of men with gonorrhea are co-infected with Chlamydia. Testing for HIV and other STDS should also be done in confirmed cases of NGU.

What should I do after being treated?

  • Make sure you take all of the medicine you have been given. Do not stop taking the medicine, even if your symptoms go away. Do not share your medicine with others.
  • Do not have sex until you have taken all of the medicine and you are sure that the discharge is gone.
  • Men can check themselves for discharge by gently squeezing the penis. The best time to do this is when you get up in the morning before you urinate. Clear fluid from the penis is normal. A discharge that looks like milk or pus means that you still have an infection. Don’t check for discharge more than once a day. Squeezing the penis more often may cause irritation and discharge even when there is not an infection.
  • Avoid reinfection by always using condoms for vaginal, oral and anal sex.
  • Contact all of the people with whom you have had sex during the last three months and advise them to get treated. Remember that there are other causes of NGU besides chlamydia. Even if your partner has a negative chlamydia test, he or she may still have given you the infection.
  • If the discharge doesn’t go away, or if it goes away and then comes back, return to your health care provider for further treatment.


What is syphilis?

Syphilis is a sexually transmitted disease (STD) or sexually transmitted infection (STI) that, when left untreated, can progress to a late stage that causes serious health problems. The infection alternates with periods of being active and inactive (latent). When the infection is active, symptoms occur. But when the infection is latent, no symptoms appear even though you still have syphilis.

Anyone who comes into close physical contact with a person who has syphilis can develop syphilis. You don’t have to have sexual intercourse to get syphilis-exposure can result from close contact with an infected person’s genitals, mouth, or rectum.

What causes syphilis?

Syphilis is caused by a type of bacterium (Treponema pallidum) that usually enters the body through the mucous membranes. An infected person can pass the disease to others (is contagious) whenever a sore or a rash is present.

What are the symptoms?

Symptoms of syphilis may not be noticed or may mimic those of many other diseases. This may cause an infected person to delay seeking medical care and can make diagnosis difficult.

The four stages of syphilis have different symptoms.

  • Primary stage: During this stage of syphilis, a painless open sore called a chancre (pronounced “shanker”) develops. Because syphilis is usually passed from person to person through sexual activities, chancres are often found in the genital area, anus, or mouth, but they may also be found wherever the bacteria entered the body.
  • Secondary stage: A skin rash and other symptoms occur during the secondary stage, which begins 4 to 10 weeks after the initial infection. Secondary syphilis is highly contagious through direct contact with the mucous membranes or other surfaces affected by the skin rash.
  • Latent stage: This stage is often called the hidden stage of syphilis because usually no symptoms are present. The latent stage is defined as the year after a person becomes infected. A person in early latent stage may be contagious. Many times, latent-stage syphilis is detected in a mother only after she gives birth to a child infected with syphilis (congenital syphilis).
  • Late (tertiary) stage: If syphilis is not detected and treated in the early stages, problems can develop because of damage caused by having the syphilis bacteria in the body for so many years. These may include heart disorders, mental disorders, blindness, other problems associated with the nervous system, and even death

How is syphilis diagnosed?

The first steps in diagnosing syphilis are discussing the history of your symptoms and sexual activities with a health professional and having a physical exam. The diagnosis of syphilis is usually confirmed with one of several blood tests.

How is it treated?

If detected and treated, syphilis can be cured with antibiotics. If not treated, syphilis may linger and may progress to the late stage where more serious health problems, such as blindness, heart disorders, mental disorders, nervous system problems, and even death, can occur.

What does the presence of  pus cells in the semen signify?

Whether pus cells are present or not. While a few white blood cells in the semen is normal, many pus cells suggests the presence of seminal infection. Unfortunately, many labs cannot differentiate between sperm precursor cells ( which are normally found in the semen) and pus cells. This often means that men are overtreated with antibiotics for a “sperm  infection” which does not really exist !

Some labs use a computer to do the semen analysis. This is called CASA, or computer assisted semen analysis. While it may appear to be more reliable (because the test has been done “objectively” by a computer), there are still many controversies about its real value, since many of the technical details have not been standardised, and vary from lab to lab.

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
  • Delayed ejaculation: In this disorder orgasm & semen discharge occurs after abnormally prolonged sexual activity.
  • Retrograde ejaculation: In which patient gets orgasm at normal time but semen in place of coming out through penile opening goes into bladder.
  • 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.

Great Semen Health

Great male semen health is important.First of all the thing to work out is the health of your sperm as it is now. This means semen analysis.

Just so you know what you are in for here it is explained for you. The following is according to the World Health Organization (WHO ) on semen samples brought in for fertility testing.

APPEARANCE. What it looks like. A brownish tinge may indicate the presence of blood, while a yellowish color could be a sign of pus cells.

VOLUME. How much there is. After two days abstinence, there should be more than 2 ml of semen specimen.

VISCOSITY. Fluidity of the sample i.e., water has a low viscosity. Semen should have a fairly watery consistency at the time of testing (about one hour after ejaculation ).

LIQUEFACTION. Ejaculated semen coagulates on contact with air, and liquefies after a short time. This liquefaction should be complete at the time of testing (about one hour after ejaculation).

AGGLUTINATION. The semen sample is examined under a microscope. Presence of motile sperm stuck together is known as agglutination and may indicate antibodies.

MOTILITY. Percentage of sperm moving and how well they are moving. Motility is graded as follows:

* Grade A — % of sperm actively, progressively motile (they move forward quickly) * Grade B — % of sperm slowly, progressively motile (they move forward slowly) * Grade C — % of sperm non-progressively motile (they move but they stay in the same place) * Grade D — % of sperm non-motile.

  1. Alkalinity or acidity of the sample (pH 7.0 is neutral). While semen pH increases over time, it should not be less than 7.2 at one hour.

SPERM COUNT. Total number of sperm (spermatozoa) present, usually recorded in millions of sperm per ml. Normal count is generally greater than 20 million sperm per ml of semen

WHITE CELL COUNT (pus), may be normally present in semen in small numbers, (i.e., less than one million per ml). Larger numbers may indicate infection, but not always.

VITALITY. Percentage of sperm which are alive (not the same as % of motile sperm). Motile sperm are obviously alive, whereas non-motile sperm may or may not be alive. At one hour, more than 50% of the sperm should be alive.

MORPHOLOGY. Examines individual stained spermatozoa samples under a microscope and determines what percentage is normal. A normal morphology level should be greater than 14%.

A semen analysis is the first step in semen health. Know where are are and then you will have a far better idea of what you have to do to get the semen health you want.


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