The Use of Flurbiprofen in Treatment of Pyospermia
Valary T. Raup, MD; Julie Szymaniak, MD; Ramy Abou Ghayda, MD; Martin Kathrins, MD
Brigham and Women's Hospital, Harvard Medical School, Boston, MA
BACKGROUND: Pyospermia, the presence of an elevated number of seminal white blood cells, is associated with poor semen parameters and diminished fertility. Pyospermia, defined as >0.9 million leukocytes/mL, is present in up to 23% of men being evaluated for infertility and may reflect an inflammatory process. While limited evidence supports therapeutic efficacy with COX-2 selective non-steroidal anti-inflammatory agents, the risk of cardiac adverse events limits general usage. We sought to examine the role of flurbiprofen, a generic non-selective non-steroidal anti-inflammatory agent, in treating asymptomatic pyospermia.
METHODS: We performed a single-institution retrospective analysis of patients with asymptomatic pyospermia treated with flurbiprofen in a male infertility clinic. Exclusion criteria included urine testing and/or physical examination concerning for active urogenital infection. Patients were prescribed flurbiprofen 100mg twice daily for two weeks, and a repeat semen analysis was performed upon completion of the course. We identified 15 patients with adequate follow-up. No patients received concurrent antibiotics. Paired T-test was used for statistical analysis.
RESULTS: The mean age in our series was 36 years (24-42), with a mean BMI of 27 (20-37). Median time from initial diagnosis of pyospermia to administration of flurbiprofen was 27 days, with a median time of 25 days to post-treatment semen analysis. Of the 15 patients, 13 showed an improvement in pyospermia after treatment (86.7%), with a mean improvement of 4.7 million leukocytes/mL (0.8-19.6). The remaining 2 men showed no change in semen leukocyte count. This result was statistically significant, with a p-value of 0.0046 (SD 4.92; 95% CI 2.20-7.19) (Table 1).
CONCLUSIONS: Flurbiprofen is a viable treatment option for asymptomatic pyospermia. Further research is needed to see how this treatment could affect fertility outcomes. 
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