Page 150 - Remedial Andrology

10.4.4.2.8 Disease management
Treatment of CP/CPPS is usually targeted at relieving symptoms [1771, 1772]. The indications and aims of
therapy are:
• reduction or eradication of micro-organisms in prostatic secretions and semen;
• normalisation of inflammatory (e.g., leukocytes) and secretory parameters;
• improvement of sperm parameters associated with fertility impairment [1773].

Only antibiotic therapy of chronic bacterial prostatitis (NIH II according to the classification) has provided
symptomatic relief, eradication of micro-organisms, and a decrease in cellular and humoral inflammatory
parameters in urogenital secretions. Although antibiotics might improve sperm quality [1773], there is no
evidence that treatment of CP/CPPS increases the probability of natural conception [1737, 1774].

Asymptomatic presence of C. trachomatis and M. hominis in the semen can be correlated with impaired sperm
quality, which recovers after antibiotic treatment. However further research is required to confirm these findings
[1769].

10.4.4.3 Epididymitis
Inflammation of the epididymis causes unilateral pain and swelling, usually with acute onset. Among sexually
active men aged < 35 years, epididymitis is most often caused by C. trachomatis or N. gonorrhoea [1775,
1776]. Sexually transmitted epididymitis is usually accompanied by urethritis. Non-sexually transmitted
epididymitis is associated with UTIs and occurs more often in men aged > 35 years [1777].

10.4.4.3.1 Diagnostic evaluation
10.4.4.3.1.1 Ejaculate analysis
Ejaculate analysis according to WHO Laboratory Manual for the Examination and Processing of Human
th
Semen (5 edn) criteria, may indicate persistent inflammatory activity. Transient reductions in sperm
counts and progressive motility can be observed [1775, 1778, 1779]. Semen culture might help to identify
pathogenic micro-organisms. Development of stenosis of the epididymal ducts, reduction of sperm count, and
azoospermia are more important potential sequelae to consider in the follow-up of bilateral epididymitis (see
Section 10.3.2).

10.4.4.3.1.2 Disease management
Treatment of epididymitis results in:
• microbiological cure of infection;
• improvement of clinical signs and symptoms;
• prevention of potential testicular damage;
• prevention of transmission;
• decrease of potential complications (e.g., infertility or chronic pain).

Patients with epididymitis known or suspected to be caused by N. gonorrhoeae or C. trachomatis must be told
to also refer their sexual partners for evaluation and treatment [1780].

10.4.4.4 Summary of evidence and recommendation for male accessory gland infections

Summary of evidence LE
Male accessory gland infections are not clearly associated with impaired natural conception. 3
Antibiotic treatment often only eradicates micro-organisms; it has no positive effect on inflammatory 2a
alterations and cannot reverse functional deficits and anatomical abnormalities.
Although antibiotic treatment for MAGIs may result in improvement in sperm quality, it does not 2a
enhance the probability of conception.

Recommendations Strength rating
Treating male accessory gland infections may improve sperm quality, although it does not Weak
necessarily improve the probability of increasing conception.
Data are insufficient to conclude whether antibiotics and antioxidants for the treatment of Weak
infertile men with leukocytospermia improve fertility outcomes.
Refer sexual partners of patients with accessory sex gland infections that are known or Strong
suspected to be caused by sexually transmitted diseases for evaluation and treatment.

SEXUAL AND REPRODUCTIVE HEALTH - MARCH 2021 149