Male accessory gland infection

Male accessory gland infection (MAGI)
Prostate with seminal vesicles and seminal ducts, viewed from in front and above
Classification and external resources
Specialty	Andrology
ICD-10	N49.8
Patient UK	Male accessory gland infection

Male Accessory Gland Infection (MAGI), also known as Male Accessory Gland Inflammation, is a condition with signs of inflammation involving one or more sites in the male genital tract. Diagnosis is made according to parameters defined by the World Health Organisation, and it is particularly made in relation to infectious or inflammatory causes of male infertility.

Although it is usually caused by infection spreading from the urethra, non-infectious causes also exist.

Definition

MAGI includes infections (bacterial, viral, fungal etc) involving one or more of the following male genital organs or tracts:

• seminal vesicles (seminal vesiculitis)
• prostate gland (prostatitis)
• vas deferens
• epididymis (epididymitis)
• testicles (orchitis)
• urethra (urethritis)
• Cowper's glands

Diagnosis

As infection has a negative impact on the secretory function of the accessory glands, findings that could indicate the presence of MAGI include:

• signs of inflammation in a semen analysis (leukocytes ≥ 1x10⁶/mL and/or elastase ≥ 230 ng/mL)
• low semen volume
• elevated semen pH
• low levels of alpha-glucosidase, fructose and zinc

WHO criteria

MAGI can be diagnosed when there are two or more factors present that meet criteria defined by the World Health Organization (WHO):

Factors	Description	For positive diagnosis
A	History of: urinary tract infection epididymitis sexually transmitted infection Physical signs: thickened or tender epididymis tender vas deferens abnormal digital rectal examination (DRE)	(i) Any one Factor A feature     plus (ii) one feature from either Factor B or Factor C
B	Prostatic fluid: abnormal expressed prostatic secretion (EPS) abnormal voided urine after prostate massage (VB3)	(i) Either one of the Factor B features     plus (ii) one feature from either Factor A or Factor C
C	Semen: leukocytes ≥ 1x106/mL semen culture with significant growth of pathogenic bacteria abnormal semen appearance increased semen viscosity (hyperviscosity) increased pH abnormal biochemistry of the seminal plasma	Any two Factor C features or (i) any one Factor C feature     plus (ii) one feature from either Factor A or Factor B

Biomarkers

One study has proposed that elevated levels of soluble urokinase-type plasminogen activator receptor (SuPAR) in seminal plasma might be useful as a marker for MAGI.

Causes

The main infectious agents are Enterobacteriaceae (such as Escherichia coli and Klebsiella), Neisseria gonorrhoeae and Chlamydia trachomatis.

One study has shown that men with MAGI who have lower serum levels of total testosterone tend to have a more complicated form of MAGI, such as involving more than one site, than those with normal levels.

Complications

Potential complications include:

• obstruction of the epididymis
• impairment of spermatogenesis
• impairmentment of sperm function
• induction of sperm auto-antibodies
• dysfunctions of the male accessory glands

These complications can result in sexual dysfunction and male subfertility.