Identification of an Infection

Biochemical evidence has shown that in males with clinically silent genital tract infections, the prostate and seminal vesicles are the organs predominantly affected and targeted by inflammation [60]. The primary role of the seminal vesicles is to provide high concentrations of fructose to the seminal plasma and is vital to the functional integrity of spermatozoa as it is the major source of glycolytic energy in order to maintain motility [18] . The reference value for normal concentrations of fructose is 13 |imol (2.34 mg) or more per ejaculate [18]. Determination of the concentration of the monosaccharide is commonly employed in laboratories for a variety of purposes including the auxiliary diagnosis of retrograde ejaculation, obstructive and nonobstructive azoospermia [61], and as a marker to assess seminal vesicular function [ 18, 62] . Changes in seminal vesicles secretory patterns can modify the composition of products of the vesicular fluid and of the ejaculate, affecting sperm function [63]. Conditions such as abnormal concentrations of zinc and fructose as well as hyperspermia, an increase in semen volume (>6 mL), and hypospermia (<2 mL) are all symptomatic of a glandular dysfunction in the seminal vesicles [64] . Inflammation from infection can cause the secretory epithelium lining the seminal vesicles to be affected, resulting in atrophy and a subsequent decrease in the seminal fructose concentration [61]. Biochemical evidence has shown that in males with clinically silent genital tract infections, the prostate is the organ that is predominantly affected and targeted by inflammation [60] . The total output of citric acid has been stated as the strongest discriminating power in terms of biochemical markers in differentiating between semen of infected and nonin-fected infertile men [65] . The threshold level for normal citrate concentrations is >52 |imol (9 mg) per ejaculate [18],

Inadequate treatment of an infection and removal of bacterial pathogens can lead to a chronic bacterial infection of these two male accessory sex glands [53]. An important symptomatic effect accompanying an infection is the damaging effect that the prostate and the seminal vesicles suffer from [18, 64]. Also, the leukocytes, predominantly PMN-granulocytes, are produced from these genito-urinary glands [66] due to the damaged tissue attracting WBC's to the site of infection [64]. During the up-regulation of cell-mediated immunity in response to infection, a coordinated response allows for PMNL to release a protease by degranulation known as elastase [16, 22].

The presence of this particular protease is considered to be a highly reliable and sensitive marker of an asymptomatic infection [23] and can be used in diagnosing a clinical infection [24] . It can also be used in clinical application as a marker of the efficiency of anti-inflammatory treatment, as well as an alternative means of monitoring the levels of seminal WBC's [22]. An enzyme-linked immunoabsorbant assay (ELISA) can be used for the quantitative detection of PMN-elastase. PMN-elastase determination has been stated as being a useful screening method to detect leukocytospermia [67]

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