Vanakkam namaste and welcome to Dr. Shah’s Clinic, my name is Dr shah, and I am a Consultant Andrologist. In this blog post, I am going to answer 2 Cardinal questions on semen culture and sensitivity that I commonly hear from my patients. 

The first question, when you should not do a semen culture and sensitivity?

The second question, when you should do a semen culture and sensitivity testing? 

So at the outset, we must understand that semen is basically made out of fluid contributed from different body organs. These are namely, prostate, the seminal vesicles, the testis and lastly epididymal fluid. 

And all these fluids in different parts of the male reproductive tract mix and come out through a common pathway that is the penile urethra. (the same path through which urine also flows)

So it is not surprising to see bacterial growth in semen when a routine semen culture and sensitivity testing is done for male factor infertility patients. 

A number of fertility doctors and infertility experts routinely recommend patients to take a semen culture and sensitivity testing, when they come to the clinic for an infertility evaluation.

However, large scale professional societies and scientific publications. have clearly suggested that routine testing of semen culture and sensitivity is not required. 

Moreover, these recommendations seem exceedingly sensible because when semen culture and sensitivity are ordered, the primary assumption is that bacterial growth in the semen affects sperm parameters.

So, what eventually happens is that on doing the test we tend to culture bacteria that may be commensal by nature ( a commensal organism is an organism that is found normally in the particular body area or fluid).

Since there are commensal organisms in the urine, it’s not surprising to find the growth of organisms in the semen. 

Some common organisms that are cultured include Streptococcus, Peptostreptococcus, E. coli, and Staphylococcus.

Doctors then tend to put patients on 1 month or 2 months of antibiotic therapy.

The joke though is that antibiotic therapy in itself can lead to low sperm motility.

Not just that, close to over 250 to 300 medications have been associated with lower sperm quality. Indiscriminate medical therapy can definitely impair male fertility potential. 

Sadly a large number of Specialists seem to forget this fact when treating patients with male factor infertility. 

So, should a semen culture be done routinely for all patients?

The answer is definitely no

A simple semen analysis is usually more than adequate. 

Also, should seminal infections be treated with antibiotics routinely? 

here again, the answer is no

However, when should a semen culture and sensitivity be done for all patients? 

Only if the patient has clinical symptoms like burning sensation while passing urine, fever pain during ejaculation, and lastly  blood in the semen. 

Moreover, this is because the patient might have had sexual exposure with an unstable partner or multiple partners. Visiting a sexologist makes sense!

Furthermore, we also know that some sexually transmitted diseases like Chlamydia and Gonorrhea need active treatment because they severely impact male fertility if left untreated. There are also numerous other infections that can cause permanent testicular damage

So in all patients where there are clinical symptoms semen culture and sensitivity is definitely recommended. 

Another bonus fact is that some studies have looked at the bacterial growth in the semen of both fertile men as well as infertile men. What they have found is that no specific organism could be associated with impaired sperm parameters.

The truth is the function of most of these bacteria in semen remains to be discovered. There are approximately 10 ^ 7 bacteria per ml of semen. That means there are more bacteria than sperm in the semen. 

Most importantly, the association between male factor infertility and the growth of commensal organisms in the semen has not been established in the pathogenesis of male factor infertility. 

To  re-emphasize the take-home points today are

• Routine semen culture sensitivity is not required for all patients
• Antibiotic treatment for commensal organism growth in semen is not required
• Semen culture and sensitivity only required for patients with clinical symptoms of urinary tract infection

I hope you enjoyed reading this short blog post. Keep watching this space for more please share this article with all your friends and loved ones. This is Dr. Shah,  Consultant Andrologist in Chennai. 

Wishing you a happy and prosperous health

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4567295/
https://www.ncbi.nlm.nih.gov/pubmed/21726934