Leucocytospermia (Pyospermia) Case of the week Leucocytospermia (Pyospermia)

White blood cells in semen If their number are more than one million in each milliliter of the ejaculate , this means asymptomatic sexually transmitted diseases ( Mycoplasma, ureaplasma & chlamydia). Semen culture should be done.

A case of azoospermia with multiple white cells in semen analysis

Leukocytospermia (pyospermia)& its effect on sperms ROS: reactive oxygen species ; GPx: glutathione perioxidase ; SOD: superoxide dismutase, GR: present on Y chromosome ; NADH, NASDPH diaphorase are correlated with sperm motility. helping helping

I. Mycoplasma genitalium Unicellular gram negative, non motile prokarytes which lack distinct cell wall. It can cause non gonoccoal urethritis (NSU)

Mycoplasma fermentans It inects human in genital tract & necrotizing tissue. It is also linked with rheumatoid arthritis. It causes chronic fatigue in patients . It causes severe respiratory infections.

Mycoplasma fermentans It attacks B cells causing inflammatory reaction Mycoplasma fermentans It attacks B cells causing inflammatory reaction. It enhance HIV replication.

Gram negative Mycoplasma hominis. Smallest free living organism known Gram negative Mycoplasma hominis. Smallest free living organism known. They have no cell wall& therefore do not gram stain. Tetracycline & erythromycin can treat both mycoplasma & uroplasma

Mycoplasma hominis M. H. are often present in vaginas Mycoplasma hominis M. H. are often present in vaginas. It colonize frequently in the genital tract of sexually active men & women. Growth of fried egg colonies on glucose agar medium within 24 – 48 hours is a characteristic of Mycoplasma hominis. It can cause pyelonephritis, pelvic inflammatory disease, post partum infection.

II. Ureaplasma urealyticum It is a normal genital flora of both men and women. It is also associated with a number of diseases in human: non specific urethritis (NSU), infertility, chorioamnionitis, still birth, premature birth, pneumonia, meningitis.

Urogenital culture: M. hominis & uroplasma urealyticum specimens work up.

III. Chlamydia trachomatis It is an obligate intercellular human pathogen. It is gram negative bacteria. It can appear as coccoid or rod shape. There are three types of this prokaryotic ( without a membrane bound nucleus) organism: 1. Serovars Ab, B, Ba or C which cause trachoma 2. Serovars D – K which cause @ urethritis ( non gonococcal urethritis), @ prostatitis, @ epididymitis , @ infertility& @ proctatitis in men. In women it can cause @ cervicitis , @ pelvic inflammatory disease & @ ectopic pregnancy. @ Perihepatitis (Fitz- Hugh – Curtis syndrome) where is inflammation of liver capsule as a part of pelvic inflammatory disease. It can also cause @ Reiter’s syndrome or reactive arthritis ( arthritis, conjunctivitis , urethritis & ulceration of the skin and mouth). 3. Serovars L1 & L2: which cause lymphogranuloma venerum. Chlamydia trachoatis is the major cause of infertility

Life cycle of chlamydia trachomatis EB : elementary body ; RB: reticulate body

Chlamydia trachomatis A : complete genome

Trachoma The world lead preventable blindness

Chlamydial urethritis ( NSU) Swab of the discharge showed no growth in culture but was positive for polymerase chain reaction to C. trachomatis

Infection of female genital tract with chlamydia trachomatis The elementary bodies infect the columnar epithelial cells of cervix, endometrium, & fallopian tubers causing pelvic inflammatory disease , salpinigitis, infertility or ectopic pregnancy.

Cytological smear of trichomonaus vaginalis : the organism is pear shaped with a diameter of 15 – 3Omicrons . The nucleus is vesicular , eccentric but cytoplasm contain eosinophilic granules. Trichomanides are also seen in in the smear (H. & E)

Chlamydia trachomatis inclusion bodies in a Mc Cay cell culture

Chlamedia salpingitis : H. E. & immune staining

Fitz – Huge- Curtis syndrome Laparoscopy shows the classic “ violin strings” adhesions between anterior liver capsule and anterior abdominal wall or diaphragm.

Fitz- Hugh –Coup syndrome “Violin- string “ adhesions can be seen Fitz- Hugh –Coup syndrome “Violin- string “ adhesions can be seen. This is spread of inflammation in pelvic inflammatory disease.

CT scan of right abdominal quadrant & pelvis in Fitz – Huge- Curtis syndrome

Fitz – Hugh – Curtis syndrome

Reiter’s syndrome It is an auto-immune condition that develop in response to inflammation of other part of the body: genitourinary or gastrointestinal infections. It is associated with HLA-B 27 gene on chromosome 6 Circinate balanitis Reactive arthritis Aphthous stomatitis Geographic tongue

Keratoderma blanorrhagicum Feet - Reiter syndrome

Ankylosing spondolytis Reiter’s syndrome is considered a precursor of other joint condition including ankylosing spondolytis