Article 131: Definition, Etiology, and Relationship of Seminal Vesiculitis with Prostatitis
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Treatment and recuperation of common diseases
seminal vesiculitis
Seminal vesiculitis is a common infectious disease in men, characterized primarily by hematospermia (blood in semen). It can be divided into acute and chronic types. It often coexists with prostatitis and is most prevalent in young adults aged 20-40. This disease can affect semen quality due to the inflammation itself, and can also affect fertility due to changes in sexual function.
Causes of disease
The main pathogens causing seminal vesiculitis are Escherichia coli, Staphylococcus, Streptococcus, and Neisseria gonorrhoeae. When adjacent organs such as the prostate, posterior urethra, and colon are infected, bacteria can take the opportunity to invade the seminal vesicles. The route of infection is mostly retrograde, meaning that bacteria ascend from the urethra and ejaculatory ducts to the seminal vesicles. Any factor that causes congestion of the prostate and seminal vesicles, such as excessive alcohol consumption, frequent sexual activity, or perineal trauma, can induce seminal vesiculitis.
What is the relationship between seminal vesiculitis and chronic prostatitis?
Both the seminal vesicles and the prostate are accessory glands of the male reproductive system, and their secretions constitute the main component of seminal plasma. Anatomically and physiologically, the seminal vesicles and prostate are closely related. Inflammation in both shares similar routes of infection and causes, and their clinical manifestations are also largely the same. Since both the prostate and seminal vesicles open into the posterior urethra and are adjacent to each other, seminal vesiculitis often occurs simultaneously with prostatitis. Prostatitis can cause seminal vesiculitis by allowing inflammatory prostatic fluid to reflux into the seminal vesicles. Conversely, inflammation of the seminal vesicles can easily spread to the prostate and affect the discharge of prostatic fluid. Research reports indicate that 80% of patients with prostate infections also have seminal vesiculitis.
Chronic prostatitis and seminal vesiculitis are mostly caused by retrograde or direct spread from the urethra, followed by lymphatic or hematogenous infection. The pathogens are mostly Escherichia coli, Staphylococcus, and Enterococcus faecalis.
Because the prostate and seminal vesicles have a close anatomical and physiological relationship, and their infection routes and clinical symptoms during the inflammatory phase are largely the same, the principles of clinical treatment are also basically the same.
What are the symptoms?
Seminal vesiculitis is divided into two categories:
1. Acute seminal vesiculitis: Systemic symptoms include general pain, chills and fever, even shivering, high fever, nausea, and vomiting. Urinary symptoms mainly include urethral burning sensation, urinary frequency, urgency, dysuria, terminal hematuria, and dribbling, similar to prostatitis symptoms. It is accompanied by severe pain in the perineum and rectum, which worsens during defecation. In severe cases, it can affect sexual function, causing excruciating pain during intercourse. A complete blood count will show elevated white blood cell count and differential.
2. Chronic seminal vesiculitis: This often results from a more severe form of acute seminal vesiculitis or incomplete treatment. Some patients develop chronic seminal vesiculitis due to frequent arousal or excessive masturbation, leading to congestion of the seminal vesicles and prostate, and secondary infection. The symptoms of chronic seminal vesiculitis are difficult to distinguish from those of chronic prostatitis, and they often coexist. The presence of blood in the semen (hematospermia) is a characteristic feature of chronic seminal vesiculitis, and it is difficult to stop spontaneously, occurring every time ejaculation and lasting for several months.
What tests should be done?
1. Laboratory tests: In the acute phase, the blood routine test showed an increase in neutrophils; the semen analysis showed a large number of red blood cells and pus cells, and most sperm were dead or absent.
2. Seminal vesiculography: Retrograde contrast imaging is performed by inserting a catheter through the ejaculatory duct orifice, or by injecting contrast agent through the vas deferens before radiography. It is used for chronic seminal vesiculitis; observation reveals incomplete seminal vesicle morphology and uneven edges.
How does Western medicine treat this?
1. Antibiotics: Since most antibiotics cannot penetrate the seminal vesicles, their efficacy is unsatisfactory. Currently, several effective antibiotics are often used in a cyclical therapy.
(1) Compound sulfamethoxazole: Due to its strong penetrability, it is a better drug. Take 2 tablets each time, twice a day, and usually continue to use it for 2 to 3 weeks.
(2) Erythromycin, lincomycin, or clindamycin: Erythromycin 0.25 g, 4 times daily, orally, preferably in combination with alkaline drugs to enhance efficacy. Lincomycin 1.5-2 g daily, divided into 3-4 oral doses; or 0.6-1.2 g daily, divided into 1-2 intramuscular injections; or 1.2-1.8 g daily, divided into 2-3 intravenous drips. Clindamycin 0.6-1.2 g daily, divided into 3-4 oral doses; or 0.45-0.9 g daily, divided into 3-4 intramuscular injections or intravenous drips.
(3) Gentamicin: 80,000 units, intramuscular injection, twice a day, one week as one course of treatment.
(4) Penicillin: 800,000 units, intramuscular injection, twice daily, for 7 days as one course of treatment. Or carbenicillin 4-10 grams daily, divided into 3-4 intramuscular injections. Or ampicillin 4-10 grams daily, divided into 3-4 intramuscular injections.
(5) Cephalexin: 2-4 grams orally in 3-4 divided doses; or cefazolin: 2-4 grams intramuscularly in 3-4 divided doses.
(6) Ciprofloxacin: 0.5-1.5g orally daily. Or norfloxacin: 0.6-0.9g orally daily. Generally, one course of treatment is 5-7 days.