How to Treat MAGI

MAGI should be treated with antibiotics when noxae influence sperm morphology and/or function, cause obstruction of the seminal tract, and express themselves with a proven mono- or multiple glandular involvement. On the other hand, the presence of bacteriospermia or leukocytospermia alone does not necessarily mean that there is a glandular infection, since temporary inflammatory episodes are likely present in the majority of sexually active men [27]. Furthermore, bacteriospermia may simply represent contamination or colonization.

A prolonged interaction between the inflammatory noxae and sperm and/or male accessory sex glands enhances an inflammatory response through the release of seminal ROS (and cytokines), which may persisted even following antibiotic treatment in patients with complicated MAGI (PV and PVE) [16]. This requires a multistep treatment. For example, patients with PVE, who have a significantly higher ROS production compared to patients with prostatitis alone or PV, should initially be treated with antibiotics (fluoroquinolones, macrolides, or doxycycline), subsequently with nonsteroidal anti-inflammatory compounds and, as a third-line therapy, with antioxidants. When this sequential pharmacological management is adopted, a significant amelioration of some sperm (forward motility and viability; leukocyte concentration and ROS production) and reproductive (pregnancy rate) parameters is achieved [22, 23].

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