Is white semen a sign of infection?

White Semen Is Not a Sign of Infection

White or whitish-gray semen is the normal color of healthy semen and does not indicate infection. Normal semen color ranges from white to gray, and this appearance is due to the natural composition of seminal fluid from the prostate and seminal vesicles.

Normal Semen Characteristics

• Healthy semen typically appears white, whitish-gray, or opalescent due to the protein content and secretions from the male accessory glands 1
• The color comes from normal prostatic and seminal vesicle secretions that contain proteins essential for semen coagulation and liquefaction 1

When Semen Color Suggests Infection

Yellow, green, or brown discoloration—not white color—may indicate infection or inflammation:

• Yellow or greenish semen may suggest the presence of white blood cells (leukocytospermia) from urogenital infection or inflammation 2, 3
• Leukocytospermia is defined as >1 million white blood cells per mL of semen and occurs in approximately 10-20% of male infertility patients 3
• Granulocytes are the most prevalent white blood cell type in infected semen (50-60%), followed by macrophages (20-30%) 3

Actual Signs of Genital Tract Infection

Look for these clinical indicators instead of semen color:

• Purulent or mucopurulent urethral discharge (yellow-green, not white) suggests gonorrhea or chlamydia infection 4, 5
• Testicular or epididymal pain and swelling indicates epididymitis, most commonly from C. trachomatis or N. gonorrhoeae in men <35 years 4
• Dysuria or urethral discomfort with visible discharge warrants Gram stain showing >5 polymorphonuclear leukocytes per oil immersion field 4, 5
• Fever, scrotal erythema, or systemic symptoms suggest acute infection requiring immediate evaluation 4

Diagnostic Approach for Suspected Infection

When infection is suspected based on symptoms (not white semen color):

• Obtain nucleic acid amplification tests (NAATs) for N. gonorrhoeae and C. trachomatis on urethral swab or first-void urine 4, 5
• Perform Gram stain of urethral discharge to identify polymorphonuclear leukocytes and gram-negative intracellular diplococci 4, 5
• Test for syphilis and HIV in all cases of suspected sexually transmitted infection 4, 5
• Consider semen analysis with leukocyte quantification if infertility is a concern, but this is not indicated for color alone 2, 3

Common Pitfall to Avoid

Do not initiate antibiotic therapy based solely on white semen color. White is the normal appearance of semen 1. Empiric treatment with ceftriaxone 250 mg IM plus doxycycline 100 mg orally twice daily for 10 days is indicated only when there are actual signs of urethritis (discharge, dysuria, positive Gram stain) or epididymitis (testicular pain, swelling) 4, 5. Approximately 80% of semen samples with elevated white blood cells show no bacterial growth, indicating that leukocytospermia itself does not always require antibiotics 3.

When to Investigate Further

• Persistent yellow-green discoloration with abnormal semen viscosity may indicate chronic prostatitis or seminal vesiculitis requiring further evaluation 6, 1
• Chronic epididymitis can cause reduced sperm count and motility even without obvious color changes, and may benefit from anti-inflammatory or antibiotic treatment 7
• Asymptomatic leukocytospermia in infertility evaluation warrants measurement of seminal elastase or pro-inflammatory cytokines (IL-6, IL-8) rather than empiric antibiotics 7