Semen cultures, urine cultures, and cultures of expressed prostatic secretions are indicated in the presence of leukospermia. In patients who demonstrate symptoms referable to the genitourinary tract or sperm agglutination, cultures are obtained after the penis, scrotum, and perineum have been cleansed with an antibacterial scrub as previously described. If cultures are positive, treatment should employ an agent to which the cultured organism is sensitive and that has no effect on spermatogenesis but good genitourinary penetration. Antibiotics with such a profile include the fluoroquinolones and tetracyclines. In the absence of a positive culture but with a high clinical suspicion of infection we employ empiric fluoroquinolone or tetracycline therapy for 3-6 weeks, treating both partners.
