Methods for the detection of male genital tract inflammation

Male genital tract inflammation is reflected by increased numbers of white blood cells (WBC) in semen. An ejaculate containing more than 10(6) WBC ml-1 semen is termed leukocytospermic. Among male infertility patients, the frequency of leukocytospermia is between 10% and 20%. By conventional light microscopy or sperm staining techniques, it is not possible to reliably differentiate WBC from immature germ cells in semen. In contrast, the cytochemical peroxidase method reliably identifies granulocytes, the most prevalent WBC type in semen. The method is cheap, fast and easy to perform. The gold standard for the detection of all WBC populations in semen is immunocytology using monoclonal antibodies. However, it is expensive and time-consuming, thus remaining a research tool at present. The measurement of granulocyte elastase in semen provides information on the number of granulocytes and their inflammatory activation. However, commercial granulocyte elastase enzyme immunoassays are expensive and due to logistical reasons often delay the results for more than 1 week. Leukocyte esterase dipstick tests lack both sensitivity and specificity for the detection of inflammatory changes in semen. For clinical purposes, the peroxidase method is ideally suited to detect inflammatory changes in semen.