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Abstract
INTRODUCTION AND OBJECTIVES: Male genital tract infections are suggested to be an important cause for male infertility. However, prospective studies investigating semen parameters after successful treatment of acute epididymitis are lacking. We present a prospective study to assess semen parameters after antibiotic treatment of acute unilateral epididymo-orchitis. METHODS: Since May 2007 we enrolled 32 men in the reproductive age (median age 30 years, range 18-66) presenting with acute unilateral epididymitis. Following the CDC guideline recommendations for antimicrobial therapy of acute epididymitis, all patients received Levofloxacin 500 mg/day for 10 days. Paired semen samples after two and twelve weeks were collected from all patients. Basic semen parameters included volume, pH value, sperm concentration, motility, and morphology according to WHO 1999 recommendations. As inflammatory markers peroxidase-positive leukocytes and polymorphonuclear elastase were quantified. Statistical analysis was performed using the Wilcoxon test. RESULTS: The bacterial spectrum included E. coli (n 12), Enterococcus faecalis (n 1), C. trachomatis (n 6), N. gonorrhoeae (n 1), and Mycoplasma spp. (n 1). In 11 patients no pathogen was identified. However, eight of those received prior antimicrobial therapy. Compared to the first analysis, a significant decrease in seminal pH value, peroxidase-positive leukocyte numbers, and seminal elastase was documented and associated with a significant increase in sperm concentration, total sperm count, progressive motility, and percentage of morphologically normal sperms after twelve weeks. Semen volume was constant over time. One patient developed persistent azoospermia after acute unilateral epididymo-orchitis. CONCLUSIONS: After successful antimicrobial therapy according to CDC guidelines semen parameters recover in patients with unilateral epididymitis. A persistent azoospermia is a rare event.
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