Treatment with levofloxacin does not resolve asymptomatic leucocytospermia - a randomized controlled study

Abstract

The manual of the World Health Organization defines leucocytospermia as the presence of >1 x 10(6) white blood cells per ml semen. Most authors consider leucocytospermia to be a consequence of inflammation due to bacterial infection. However, the efficacy of antibiotic therapy was not unequivocally demonstrated until now. We started a prospective, randomized, controlled study in 36 patients, who consulted our department for infertility with leucocytospermia. None of the patients reported any symptoms of genital infection. The patients were assigned randomly to two groups: group 1 received 250 mg levofloxacin once a day over 10 days, patients of group 2 received no therapy. Semen analysis was repeated 2 weeks later. After administration of levofloxacin, a mean decrease of leucocyte count of 45.8 +/- 72.2% compared with a decrease of only 3 +/- 109.2% in the untreated group was observed. However, this difference is not statistically significant. There were no significant differences between the two groups with respect to leucocyte count, sperm count and sperm cell after treatment. We conclude from our study that antibiotic therapy does not provide benefit for treatment of asymptomatic leucocytospermia.

Treatment of Leukocytospermia in Male Infertility: A Systematic Review

“…After screening abstracts and titles, we excluded 1,083 studies. A total of 30 articles were read in full and evaluated and 11 articles subsequently met the criteria for the systematic review [1011121314151617181920]. Nineteen articles were excluded (non-RCT, 9; duplication, 7; did not meet eligibility, 3) (Fig.…”

“…Three trials showed statistically significant improvement of sperm concentration and/or motility between the treated and untreated group [101119]. However, there were no statistically significant differences in sperm parameters between groups in 3 trials [151720]. Interestingly, Merino and Carranza-Lira [13] found that a statistically significant difference in seminal pH was shown in the group treated with trimethoprim/sulfamethoxazole compared with placebo.…”

“…Antibiotics resulted in a statistically significant resolution of leukocytospermia in 5 trials, in contrast to 3 trials which showed non-significant effects of antibiotics on the resolution of leukocytospermia (significant effect [1112141619]/non-significant effect [151720]). Lewis-Jones et al [16] reported significant resolution of leukocytospermia, but they used data from all participants who had undergone antibiotic treatment.…”

“…All studies showed a statistically significant decrease in the number of seminal bacteria (Table 2) [111920]. …”

Leucospermie, stress oxydatif et fertilité masculine : certitudes et hypothèses

“…Enfin les normes de la leucospermie retenues pour l'inclusion des patients ainsi que son évaluation étaient très variables. Toutefois certaines étu-des comme celle de Branigan et al sur des groupes de patients bien définis, ont permis de montrer que le traitement antibiotique améliore de taux cumulatif de grossesse sur six mois chez des patients leucocytospermiques présentant une infertilité par ailleurs inexpliquée [65], ce qui n'est pas le cas si un tel traitement est donné de façon indifférenciée à tous les patients infertiles avec une leucocytospermie [66].…”