What is the treatment for male accessory gland infections causing infertility and erectile dysfunction?

Treatment of Male Accessory Gland Infections for Infertility and Erectile Dysfunction

Antibiotic therapy is recommended only for chronic bacterial prostatitis (NIH Type II), as it may improve sperm quality but does not necessarily improve conception rates, while erectile dysfunction in these patients should be evaluated and managed separately with standard ED treatments. 1

Antibiotic Treatment Approach

When to Treat with Antibiotics

• Treat only documented chronic bacterial prostatitis (Type II) with appropriate antibiotics, as this has shown symptomatic relief, eradication of microorganisms, and decreased inflammatory parameters in urogenital secretions 1

• Do NOT treat chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) with antibiotics for fertility purposes, as there is no evidence this increases the probability of natural conception 1

• Do NOT treat leukocytospermia alone without evidence of infective organisms, as this does not improve conception rates 1

Specific Pathogen-Directed Therapy

• For epididymitis in men <35 years: Ceftriaxone 250 mg IM single dose PLUS doxycycline 100 mg orally twice daily for 10 days (covers N. gonorrhoeae and C. trachomatis) 2

• For epididymitis in men >35 years: Ofloxacin 300 mg orally twice daily for 10 days OR levofloxacin 500 mg orally once daily for 10 days (covers enteric organisms) 2

• Treat specific documented infections: Ureaplasma urealyticum and Mycoplasma hominis are associated with male infertility and warrant treatment, while Ureaplasma parvum and Mycoplasma genitalium are not 1

• Asymptomatic Chlamydia infection may improve sperm parameters with treatment, but unclear if it improves conception rates 1

Critical Partner Management

• Always refer sexual partners of patients with accessory sex gland infections caused by or suspected to be sexually transmitted diseases for evaluation and treatment 1

• Partners should be evaluated if contact occurred within 60 days prior to symptom onset 2

Erectile Dysfunction Management in MAGI Patients

Evaluation and Hormonal Assessment

• Evaluate all male patients with HCV-related or chronic inflammatory conditions for erectile dysfunction and hormonal status, as these patients show higher prevalence of ED and abnormally low testosterone levels independent of hepatic damage severity 1

• Check testosterone levels in men with accessory gland infections presenting with ED, as correction of hormonal deficiency may improve quality of life 1

ED Treatment Options

• Phosphodiesterase-5 inhibitors (PDE5i) are first-line therapy for erectile dysfunction in these patients, with tadalafil being FDA-approved for ED treatment 3

• Tadalafil dosing: 2.5-20 mg taken as needed up to once daily, with demonstrated efficacy in improving erectile function across multiple trials 3

• Contraindications to PDE5i therapy: Do not use in patients taking nitrates, guanylate cyclase stimulators (riociguat), or recreational "poppers" due to risk of severe hypotension 3

Adjunctive Measures for Fertility Optimization

Supportive Care for Acute Inflammation

• Bed rest, scrotal elevation, and analgesics until fever and local inflammation decrease 2

• Re-evaluate within 3 days if no improvement on antibiotic therapy 2

Lifestyle Modifications

• Weight loss, physical exercise, and smoking cessation can enhance sperm parameters and should be strongly encouraged, as infertile men have higher cardiovascular and overall mortality risk 1

• Screen all infertile men for modifiable cardiovascular risk factors 1

Key Clinical Pitfalls

Common mistake: Treating leukocytospermia or CP/CPPS with antibiotics expecting improved fertility—this is not evidence-based and wastes resources 1

Critical warning: Always consider testicular torsion in the differential diagnosis of acute scrotal pain, as this is a surgical emergency requiring prompt intervention 2

Important caveat: While antibiotics may improve sperm quality in documented bacterial prostatitis, there is no evidence this translates to improved natural conception rates—couples may still require assisted reproductive technology 1

Testosterone caution: Never prescribe testosterone monotherapy to males interested in current or future fertility, as it suppresses spermatogenesis 1

When Antibiotics Fail or Are Not Indicated

• Consider assisted reproductive technology (ART) including IVF/ICSI for couples with persistent male factor infertility despite appropriate treatment 1

• Functional and anatomical damage from infection is often permanent and not reversible by antibiotic treatment, emphasizing the importance of prevention over treatment 4