[Urinalysis] Sperm

                                          Image by Cooldesign, from FreeDigitalPhotos.net

When we take a look at urine under the microscope, there are things we tend to look for. Most of them seem pretty clear cut on why they are reportable - they are signs of infection or conditions that the doctors can then treat. Bacteria, and WBC are both obvious signs of urinary tract infections; yeast signal a yeast infection. White cells casts can predict pyelonephritis, and red cell casts glomerulonephritis.

 But what about sperm?

Shouldn't sperm be something we see in every male midstream sample?

Nope.

Spermatozoa are only normal if the sample isn't midstream, AND the patient has had sexual activity within five hours of collection. As collection protocol for urinalysis is midstream, we should not expect to see sperm in sample.

Sperm is seen in midstream urine when the bladder sphincter fails to produce the usual tightening before ejaculation. The sperm then travel into the bladder instead of out of the body, and are excreted during urination. This condition is called retrograde ejaculation, and can be due to nerve damage, diabetes, medication side effect, post bladder/prostate surgery, or weak muscle condition. This is one of the more common causes of male infertility, and can be treated.

Another reason sperm may be seen in male patients' urine is prostatitis. When the prostate is swollen with fluid, it can block off the paths that sperm would normally travel, causing a redirect. This can be due to prostate cancer, recent surgery, bacterial infection of the prostate or urinary system, or arousal without ejaculation. Sometimes this is also seen when methods to avoid mess are used in sexual expression; the interference (or application of Hughes Method) to prevent ejaculation can cause backflow into the bladder. Unless other symptoms are present, treatment is generally unnecessary.

Reporting sperm in male urine can be a real clue to infertility patients

.What about females and children though? You should never see sperm in a child's urine. If you do, you must report it; that child could be sexually abused. I would advise confirming with a second sample if you can, to ensure there are no mistakes. Know that you cannot be sued for bringing this to your hospitals' attention so they can follow up; this is part of your duty to report as a technologist. In one case, the parents attempted to sue, but failed. Seeing sperm in an adult female's sample is a non-clinical finding.

[Hot Topic] CBS Blood Donation Policy, Update

Last year, the big news was Canadian Blood Service's attitude change towards accepting blood donations from gay men. Previously completely banned, gay men can now donate blood if they have had no same sex sexual activity for the past five years.

This is a huge step for Canadian Blood Services.

Last year, they had still not quite ironed out how this change would echo through the rest of their policies.

For instance, what about women who had had sex, even once, with a man who had had a male sexual experience? Up until last May, they were also still excluded from giving blood. Even last May, when I called and spoke with a CBS associated nurse, they were still excluding those women from giving blood, as they "just didn't know" how things would play out.

I called back this year and clarified. Now the question for women has been changed from

"Are you a woman, who has had, even once, had sex with a man, who has had sex with a man?" 

to,

"Are you a woman, who has had sex with a man, who has had sex with a man, in the last five years?"

I.e. if the same sex sexual experience took place greater than five years ago, then you can donate.

This is particularly applicable for bisexual men and women, or partner's of those who "experimented" in college. Previously, if they were aware of their partner's past, they would have been permanently deferred. Now, if it has been more than five years since the MSM encounter, women are eligible to donate again.

As always, if you have questions about your eligibility to donate blood in BC, call the donor line at 1888- 2DONATE, and ask for the nurseline. They will be able to help address concerns about whether you are a good fit for a donor.

CBS continues to collect data to see if it can relax it's deferral policies in the manner any further.

It will likely be at least ten years of data collection though before we see any more change. One step at a time though is all we can do.

Hopefully, the screening process will continue to move more towards an actual sexual-risk based policy based on number/frequency of sexual partners rather than the sexual orientation of the donor.