Pus Cells in Semen Report
“Pus cells” on a semen report usually refers to white blood cells or other round cells seen under the microscope. This does not automatically mean there is a bacterial infection, and it does not mean every man needs antibiotics. WHO/EAU use a threshold of more than about 1 million white blood cells per mL for leukocytospermia, ideally confirmed with a peroxidase test because immature germ cells can look like white cells on routine microscopy. Symptoms, examination, urine or semen culture and STI risk determine whether infection treatment is needed.
What are pus cells in semen?
Laboratories may report “pus cells,” “round cells,” “WBCs” or “leukocytes.” These are not always interchangeable. Round cells can include white blood cells and immature sperm-forming cells. A confirmatory peroxidase test can help identify true leukocytes when the number is increased.
What is leukocytospermia?
Leukocytospermia generally means more than 1 million white blood cells per millilitre of semen. It is a marker of inflammation, but EAU guidance emphasises that it is not a reliable stand-alone marker of bacterial or viral infection. Some asymptomatic men have leukocytospermia without a treatable organism.
Possible causes
- Prostatitis or epididymal/testicular infection.
- Sexually transmitted infection in selected men.
- Non-infectious inflammation.
- Recent fever or systemic inflammatory illness.
- Varicocele and oxidative stress may coexist but do not make every elevated WBC result an infection.
- Laboratory misclassification of immature germ cells as “pus cells.”
When is culture or infection testing useful?
Testing is guided by symptoms and risk. Burning urination, urethral discharge, painful ejaculation, pelvic discomfort, scrotal pain/swelling, recurrent UTI or a relevant sexual exposure increase the reason to look for infection. A semen culture can be useful in selected infertility cases, but a positive culture must also be interpreted carefully because contamination is possible.
Do pus cells reduce sperm quality?
Inflammation can increase oxidative stress and may be associated with poorer sperm function in some men. However, the relationship between isolated leukocytospermia and natural fertility or ART outcomes is inconsistent. EAU guidance notes that treating leukocytospermia alone, without evidence of an infective organism, has not been shown to improve conception rates.
Treatment
| Finding | Typical approach |
|---|---|
| Symptoms + proven bacterial infection | Treat the identified infection according to culture/susceptibility and clinical diagnosis |
| STI suspected/confirmed | Appropriate STI testing, treatment and partner management |
| Leukocytospermia without symptoms or organism | Do not reflexively prescribe repeated antibiotics; evaluate context and repeat if needed |
| Round cells but unclear WBC count | Confirm with peroxidase testing when clinically important |
| Persistently abnormal semen parameters | Evaluate broader male infertility causes rather than attributing everything to “pus cells” |
When to seek urgent care
- High fever with severe scrotal pain/swelling.
- Sudden severe testicular pain.
- Inability to pass urine with fever.
- Severe systemic illness or rapidly worsening symptoms.
What to do with an isolated abnormal report
If you feel well and the only finding is “pus cells,” do not panic or self-start antibiotics. Check how the laboratory quantified the cells, whether leukocytes were confirmed, and whether the rest of the semen parameters are abnormal. A urologist can decide whether urine testing, culture, STI testing or repeat semen analysis is appropriate.
Pus cells, round cells and infection are not the same thing
Semen microscopy may report ’round cells’, but not every round cell is a white blood cell. Immature germ cells from the testis can look similar, and laboratories may use additional methods such as peroxidase testing to confirm true leukocytes. This is one reason a single ‘pus cells +’ line should not automatically lead to antibiotics.
True leukocytospermia can occur with inflammation or infection, but the semen finding alone does not identify the organism or prove that infection is causing infertility. Urinary symptoms, urethral discharge, epididymal/testicular pain, STI risk, urine testing and culture guide the next step. Antibiotics are most useful when there is clinical or microbiological evidence of infection rather than simply because a report contains white cells.
Emergency warning signs
Pus cells on a semen report are not automatically an emergency or proof of infection. Seek prompt care for high fever, severe scrotal pain/swelling, spreading redness, painful inability to pass urine or feeling acutely unwell, as these may indicate a significant urinary or genital infection.
What to bring for consultation
Bring these if available:
- The semen report showing how pus cells/WBCs were quantified.
- Any urine routine, urine culture or semen culture.
- History of fever, dysuria, discharge, painful ejaculation or scrotal pain.
- Recent antibiotics and any STI testing.
- Previous semen analyses for comparison.
FAQs
Do pus cells in semen always mean infection?
No. They indicate round cells or leukocytes and may reflect inflammation without a bacterial infection. Confirmation and clinical context matter.
How many pus cells are abnormal?
WHO/EAU define leukocytospermia as more than about 1 million white blood cells/mL, preferably confirmed with a peroxidase test.
Should I take antibiotics for pus cells?
Not automatically. Antibiotics are appropriate when there is a diagnosed or strongly suspected infection, not simply because one report lists pus cells.
Can pus cells lower sperm motility?
Inflammation can be associated with oxidative stress and poorer sperm function, but the effect varies and isolated leukocytospermia is not a complete explanation for every abnormal semen analysis.
Should my partner also be treated?
Only when a specific infection, especially an STI, requires partner evaluation/treatment.
Related reading
- Semen Analysis Report Explained
- Low Sperm Motility: Causes and Treatment
- Repeat Semen Analysis: Why It Is Needed
- Male Infertility: Causes, Tests and Treatment
- Urologist in Latur
References
- World Health Organization. WHO laboratory manual for the examination and processing of human semen, 6th ed https://www.who.int/publications/i/item/9789240030787
- European Association of Urology. EAU Guidelines on Sexual and Reproductive Health: Male Infertility. 2026 https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/male-infertility
- American Urological Association/American Society for Reproductive Medicine. Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline (2020; Amended 2024) https://www.auanet.org/documents/Guidelines/PDF/2024%20Guidelines/Male%20Infertility%20Unabridged%20Final.pdf