Causes of Seminal Vesiculitis
Seminal vesiculitis is primarily caused by bacterial infections, with Chlamydia trachomatis and Neisseria gonorrhoeae being the most common pathogens in sexually transmitted cases. 1
Primary Infectious Causes
- Chlamydia trachomatis is a frequent causative organism of seminal vesiculitis, which can occur with or without symptomatic urethritis or epididymitis 1
- Neisseria gonorrhoeae is another major bacterial pathogen that can lead to seminal vesiculitis, often in association with urethritis 2
- Ureaplasma urealyticum and Mycoplasma genitalium have been implicated in some cases of urethritis and associated seminal vesiculitis 2
- Trichomonas vaginalis can occasionally cause urethritis that may extend to the seminal vesicles 2
- Enteric organisms may cause seminal vesiculitis, particularly in men over 35 years of age or those who practice insertive anal intercourse 2
- Pseudomonas aeruginosa and other biofilm-forming bacteria can cause persistent seminal vesiculitis that is difficult to treat due to their propensity for tissue persistence 3
Pathophysiology and Progression
- Seminal vesiculitis typically develops as an extension of infection from the urethra or as a complication of epididymitis 1
- The infection can spread in a retrograde fashion from the urethra through the ejaculatory ducts to the seminal vesicles 2
- Asymptomatic urethritis may precede the development of seminal vesiculitis, which can later progress to epididymitis if left untreated 1
Risk Factors
- Unprotected sexual intercourse with infected partners is the primary risk factor for sexually transmitted infections that can lead to seminal vesiculitis 2
- Multiple sexual partners increase the risk of exposure to pathogens 2
- History of other sexually transmitted infections may predispose to seminal vesiculitis 2
- Immunosuppression, including HIV infection, increases susceptibility to fungal and mycobacterial causes of seminal vesiculitis 2
Clinical Presentation and Diagnosis
- Seminal vesiculitis may present with hemospermia, painful ejaculation, perineal discomfort, or be completely asymptomatic 4, 5
- Diagnosis often requires:
- Urethral smear showing >5 WBCs per oil immersion field 2
- Culture or nucleic acid amplification tests for N. gonorrhoeae and C. trachomatis 2
- Transrectal ultrasound to visualize inflammation of the seminal vesicles 4
- In intractable cases, transurethral seminal vesiculoscopy may be necessary for definitive diagnosis 5
Treatment Considerations
- Treatment should target the specific causative organism when identified 2
- For suspected chlamydial or gonococcal seminal vesiculitis:
- Ceftriaxone 250 mg IM in a single dose PLUS Doxycycline 100 mg orally twice daily for 10 days 2
- For suspected enteric organism infection or in patients allergic to cephalosporins/tetracyclines:
- Ofloxacin 300 mg orally twice daily for 10 days OR Levofloxacin 500 mg orally once daily for 10 days 2
- Fluoroquinolones (such as ciprofloxacin) have shown efficacy in treating seminal vesiculitis 4
- In intractable cases, direct irrigation of the seminal vesicles with antibiotics via transurethral seminal vesiculoscopy may be necessary 5
Important Clinical Considerations
- Failure to improve within 3 days of treatment requires reevaluation of both diagnosis and therapy 2
- Sexual partners should be evaluated and treated if the seminal vesiculitis is caused by sexually transmitted pathogens 2
- Patients should avoid sexual intercourse until they and their partners are cured 2
- Persistent symptoms after appropriate antibiotic therapy warrant further investigation for other conditions such as tumor, abscess, or fungal/tuberculous infection 2