How much pus cells in sperm is normal? Should you treat pus cells in semen?

Hey guys! In this short 2 min blog post, we will quickly understand what to do if you notice pus cells in semen. Watch the video below

Okay, so you are trying for a child desperately for the last 2 or 3 years. Sadly a pregnancy is just not happening. Moreover, your andrologist or male fertility specialist punished you with a battery of expensive tests.

Among these tests is the famed ‘semen analysis test‘ or sperm test. The D-Day comes, you get your report and you are SHOCKED.

pus cells in semen
pus cells in semen

You notice the ONE THING you do NOT want to see in your goddamn report….

PUS CELLS and numerous pus cells, so many damn PUS CELLS competing with your sperm for honor and space (I know the joke sounds cheesy).

And you are going like MAD. Your fertility specialist says that, your pus cells in the semen are the reason your sperms motility is so low

pus cells in semen
pus cells in semen

Moreover, its the pus cells in your goddamn sperm that causing infertility. What should you do? The answer is below.

How much pus cells in sperm is normal?

Well on average that is, if you look at the average semen analysis report, you should see anywhere between 1-2 cells per high power field.

The most important thing to understand here is that, these pus cells, also called as ’round cells’ can be of 2 types.

The first type of round cells is the typical ‘White blood cell’ or so called ‘pus cells’ that is seen…..if their is an infection. Secondly, the next type of round cell can be simply an immature spermatogonial cell.

Either way, in a typical sperm test, both cells are considered as ’round cells’.

So DO NOT hit the PANIC button, once you notice pus cells along with your sperm.

To make things easy, I am going to systematically give you a treatment strategy for those damn pus cells. The strategy will be based on what should be done, depending on the number of pus cells seen per high power field

2-4 pus cells in sperm

For both 1-2 and 2-4 pus cells seen in your semen analysis report, no active treatment is required. However, the one exception is, if their are clinical symptoms like burning sensation while passing urine and/or pain while ejaculation, treatment will be required

To summarize here is what you should do

Step 1 – Repeat your semen analysis and see if you get the same 2-4 cells per high power field

Step 2 – If Yes, and you also have symptoms, take antibiotics after doing a semen culture and sensitivity

Lastly, Step 3- if No, and you have no symptoms, then no further treatment is required

Ok, now to the next part

4-6 pus cells in semen

Alright then, you notice you have 4-6 pus cells. What should you do?

Step 1: Once again, repeat the sperm test

Step 2: You need to do a leuco-screen test. This will differentiate whether the pus cells are immature sperm cells or plain pus cells

Step 3: If the round cells are immature sperm cells, no further treatment is required

Step 4: Fourthly, if the round cells are pus cells and you have no symptoms, no further treatment is the recommendation

Lastly, Step 5: Pus cells with symptoms, then please do a semen culture and sensitivity and follow up with antibiotics

8-10 pus cells in semen

Here again, follow the steps below

Step 1: Repeat semen analysis

Secondly, Step 2: Next leuco-screen test

Thirdly, Step 3: If report shows immature cells, no further treatment

Lastly, Step 4: However, if they are pus cells and you have symptoms, semen culture followed up with a course of antibiotics is definitely required

Now to the last part of the discussion. What should you do if you notice the below finding in your report?

20-25 pus cell seen in semen

Step 1: Repeat your sperm test once again

Secondly Step 2: Do a leuco-screen test

Thirdly, Step 3: Do a trans-rectal ultrasound of your prostate and seminal vesicles to rule out infections

Fourthly Step 4: Antibiotic course if semen culture shows growth of pathogenic organisms

So, thats about it guys

I hope you found this article of some value. Do of course visit an andrologist or sexologist near you

A very important point to bear in mind is that, if you notice pus cells in semen, a treatment is only required if and when you have certain symptoms.

Some of these symptoms are namely

1. Burning pain while passing urine

2. Also, the presence of burning pain while ejaculation

3. Pus discharge from the organ

4. Foul smelling semen and the presence of blood in semen (hematospermia)

Unless otherwise, you dont have any of the aforementioned symptoms along with pus cells, a general rule of the thumb is that, you do NOT need any major treatment.

So, thats about it!

I hope you found this article useful and informative. Please share this article with all your friends and loved ones

Kindly drop in your comments, I will do my best to respond to all of them. Keep watching this space for more interesting articles.


Sigman M, Lopes L. The correlation between round cells and white blood cells in the semen. The Journal of urology. 1993 May 1;149(5):1338-40.

Solis EA, Gatti VN, Bouvet BR, Brufman AS, Provenzal C, Feldman R. Round cells in semen and genital infections. Archivos espanoles de urologia. 200

8 thoughts on “How much pus cells in sperm is normal? Should you treat pus cells in semen?”

  1. Continue teaching me on this because I have puscell in my sperms but I want to do a second test results because I doubted the first one

  2. Hi Dr. Shah,

    Good post indeed. My semen report shows 35 – 40 pus cells!

    I have done semen test 10 days before, the pus cells were 20 -25, a Dr prescribed me a course of 10 days of antibiotic. when I completed the course I did the semen test again. I was shocked with the pus cells increasing to be 35 – 40!!

    What should I do next?

    Thank you in advance.

  3. Hello sir my semen analysis shows 8-10 hpf pus cells present in semen and liquification time is >90 min and viscosity has increased. Overall results says NORMOZOOSPERMIA
    INCREASED VISCOSITY. Do i require treatment?


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