Spermatorrhea that has turned into purulent semen is called purulent semen; clearing heat, promoting diuresis, and detoxifying are the primary treatment methods.

The key is to remove pus and necrotic tissue from the semen and preserve the sperm.

Mr. Wang is 33 years old and has been married for 8 years. Six years ago, they had a healthy daughter. He now wants a second child, but despite not using any contraception for the past two years, his wife has not become pregnant. Mr. Wang experiences urethral discomfort, burning, itching, and pain; yellow urine; sometimes a small amount of clear discharge; increased urination at night; lower abdominal discomfort; pain in the pubic area; and discomfort in the scrotum and testicles. He also experiences burning pain in the urethra, urinary frequency, urgency, and even difficulty urinating. During ejaculation, he experiences slight pain or discomfort in the seminal duct (vas deferens) or lower abdominal discomfort.

The doctor then recommended a semen analysis, which revealed the following: the semen was slightly yellow and viscous; the sperm motility was 50%; the sperm count was weak, with a count of 6 × 10⁸/mL; the liquefaction time was 2 hours; the total semen volume was 2.5 mL; and o-toluidine staining confirmed the presence of pus cells in the semen, with a white blood cell count greater than 5/HP. The doctor diagnosed Mr. Wang with pyospermia.

Under normal circumstances, there are no pus cells in semen, and the white blood cell count is less than 1×10⁶/mL. If pus cells are found in the semen, and the white blood cell count is greater than 1×10⁶/mL (5 cells/HP), and it is accompanied by infertility, it is called pyospermia, also known as excessive white blood cells in semen.

Pyospermia is a common cause of male infertility, accounting for approximately 17% of all male infertility cases. The occurrence of pyospermia is mainly related to reproductive system infections, such as epididymitis, prostatitis, or seminal vesicle inflammation. In traditional Chinese medicine, it corresponds to conditions such as "spermatic turbidity," "urinary tract infection," or "spermatic heat."

Generally speaking, the causes of pyospermia are as follows: a fondness for spicy and rich foods, excessive drinking, which generates dampness and heat, and the damp-heat evil descends to the seminal vesicles along the meridians; or phimosis, long-term accumulation of smegma, infection with damp toxins, or immoderate sexual activity, exposure to pathogenic factors, incomplete treatment, the evil lurking in the seminal chamber, accumulating over time, transforming into toxins and putrefaction, leading to pyospermia; excessive sexual activity, or excessive consumption of warm and dry foods, or febrile diseases damaging yin, leading to kidney yin deficiency, yin deficiency and fire excess, which scorches the seminal fluid and transforms into pus.

The key pathogenesis of pyospermia lies in the interaction of dampness, heat, and toxins, which accumulate in the seminal vesicles, leading to pus formation. Since pyospermia is caused by bacterial infection, antibacterial traditional Chinese medicine is the first line of treatment to prevent prolonged illness from causing inflammatory adhesions, which could obstruct the vas deferens and lead to infertility. While undergoing drug treatment, warm sitz baths or hot compresses can be used in conjunction. For patients with prostatitis, prostate massage should be performed to promote the absorption of inflammation and the expulsion of bacteria.

The first step in treating pyospermia is to eliminate the underlying cause. Treatment may involve oral administration of ofloxacin and metronidazole, or ceftriaxone, metronidazole, and azithromycin. Generally, a combination of traditional Chinese and Western medicine is used to reduce the toxic side effects of antibiotics. Furthermore, individualized treatment based on syndrome differentiation leads to more significant results. Based on Mr. Wang's symptoms of damp-heat in the lower abdomen, including a slippery and rapid pulse, a red tongue with a yellow and greasy coating, and constipation, the treatment principle is to clear heat, promote diuresis, detoxify, and drain pus. The formula "Anti-inflammatory and Fertility-Boosting Decoction" is used. Honeysuckle, forsythia, dandelion, and scutellaria clear heat, detoxify, and dry dampness; talc, artemisia capillaris, and calamus clear heat, promote diuresis, and calm the mind; agastache, coix seed, and cardamom resolve dampness, detoxify, and drain pus; and salvia miltiorrhiza and red peony root clear heat, invigorate blood, and remove blood stasis.

Normal semen is a clean, grayish-white liquid that should not contain any substances other than sperm and seminal plasma. However, in cases of genitourinary infections such as orchitis, epididymitis, prostatitis, and urethritis, the inflammatory exudate and purulent secretions at the site of the lesion often result in a large number of white blood cells and pus cells being found during semen analysis.

Pyospermia is caused by bacterial infection, so antibiotics are the first line of treatment. A mixture of penicillin (800,000 units) and streptomycin (0.5 g) is administered intramuscularly twice daily for 7 days. Generally, bacteria in the epididymis are difficult to eradicate, so treatment must be thorough. After the pain subsides, oral anti-inflammatory medication should be continued for 2-4 weeks, such as norfloxacin (0.2 g) four times daily.

Pyospermia falls under the category of damp-heat accumulation in Traditional Chinese Medicine (TCM), therefore treatment should focus on clearing heat and dampness, and unblocking the seminal vesicles. The prescription is as follows: 9g of Sophora flavescens, 9g of Phellodendron chinense, 9g of Gardenia jasminoides, 12g of Lonicera japonica, 12g of Hedyotis diffusa, 9g of Chrysanthemum indicum, 12g of Coix lacryma-jobi, 9g of Alisma plantago-aquatica, 9g of Dianthus superbus, 9g of Rehmannia glutinosa, and 9g of Lindera strychnifolia. Decoct in water and take one dose daily. A course of treatment is half a month. If the condition is prolonged and accompanied by symptoms of kidney deficiency such as lower back and knee weakness, dizziness, and fatigue, remove Hedyotis diffusa and add 9g each of Rehmannia glutinosa (processed), Polygonum multiflorum, and Dipsacus asper; the effect will be even better.

In addition, patients should pay attention to the following points:

1. Alcohol is prohibited during treatment.

2. Follow-up after one course of treatment.

3. Patients should take medication on time and in the prescribed dosage. Because the treatment of non-gonococcal urethritis differs from gonorrhea in that it cannot be treated with a short-term, full-dose regimen, and requires more frequent and prolonged medication, patients may easily forget to take their medication due to work or other commitments, or stop taking it after 1-2 days when the symptoms have subsided, affecting the treatment's effectiveness or causing a relapse. In such cases, do not rush to change medications.

4. Sexual partners with infections should be treated simultaneously. If a patient's symptoms persist after treatment, or recur after symptoms have disappeared, the most likely reason is that the sexual partner has not been treated. Sexual intercourse with an untreated partner can transmit the pathogen back to the patient.

5. If the patient experiences recurrent episodes, complications such as prostatitis should be suspected. Appropriate bacteriological examinations should be performed, and timely treatment should be initiated. Relapsed patients require detailed clinical and bacteriological examinations and targeted treatment to achieve a complete cure.