Value of detecting leukocytospermia in the diagnosis of genital tract infection in subfertile men

Objectives: To evaluate whether detection of leukocytospermia in a routine semen analysis is of diagnostic value in selecting men with an 'actual' microbial infection and to assess the association between leukocytospermia and a history of bacterial and vital infections. Design: Prospective clinical study. Setting: Infertility clinic at the Center for Reproductive Medicine, Academic Medical Center, Amsterdam, the Netherlands. Patient(s): One hundred eighty-four men among subfertile couples attending our infertility clinic. Intervention(s): The number of leukocytes was assessed in three semen samples. Serologic tests were performed, as was transurethral culture after digital prostatic massage. Main Outcome Measure(s): Diagnosis of actual bacterial and viral infections in relation to seminal leukocyte concentrations. The association of a history of sexually transmitted diseases with seminal leukocyte concentration. Result(s): An actual bacterial infection was present in 39% of men, and 11% of men had an actual viral infection. The area under the receiver operating curve, which was used to determine whether detection of leukocytospermia was of diagnostic value in identifying men with actual bacterial or viral infections, was 0.55 and 0.56 for bacterial and viral infection, respectively. A past infection with N. gonorrhoeae was associated with the presence of leukocytospermia. A past vital infection was not associated with leukocytospermia. Conclusion(s): Detection of leukocytospermia appears to be of no diagnostic value for selection of men with actual microbial infections, but leukocytospermia is associated with a history of gonorrhea.