Both qualitative and quantitative virologic measurements were compared between blood and genital compartments for 128 men infected with human immunodeficiency virus type 1 (HIV-1) to address several controversial issues concerning HIV-1 shedding in semen and to obtain further information about the distribution of virus between these two compartments. Evidence for viral compartmentalization was suggested by earlier studies that noted the poor correlation between blood and seminal virus load, phenotype, and genotype. Further support for this viral compartmentalization was based on the following observations between semen and blood: lack of association between culturability of virus in semen and viral RNA level in blood, discordant distribution of viral phenotypes, discordant viral RNA levels, a weak correlation between viral RNA level in semen and CD4 cell count in blood, differences in the biologic variability of viral RNA levels, and differences in the virus load response to antiretroviral therapy.

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The finding of moderate or severe inflammation in only 5% of 97 patients argues for the need to reevaluate current concepts of the pathophysiology of the chronic prostatitis/chronic pelvic pain syndrome.

Because exposure to semen is important for the sexual transmission of human immunodeficiency virus type 1 (HIV), the relationship of stage of infection and antiviral chemotherapy to isolation of HIV from semen was investigated. Whereas HIV was isolated from peripheral blood mononuclear cells of all seropositive persons tested, it was isolated from semen in only 11 (32%) of 34 men, including 3 of 6 who were studied sequentially over time. HIV was isolated from 6 (32%) of 19 semen specimens from 14 asymptomatic persons (Centers for Disease Control [CDC] class II or III) and from 10 (28%) of 36 semen specimens from 20 symptomatic patients (CDC class IV). Isolation of HIV from semen did not correlate with CD4+ or CD8+ T lymphocytes counts or zidovudine therapy. Seropositive men may shed HIV in semen early in the course of infection, and zidovudine therapy seems to have no effect on the recovery of HIV and, thus, on the potential for sexual transmission of HIV.