Semen granulocyte elastase: its relevance for the diagnosis and prognosis of silent genital tract inflammation

zElastase-inhibitor complex was assessed by immunoassay in the seminal plasma of 312 men attending the outpatient infertility clinic. Using receiver operating characteristic (ROC) curve analysis, elastase at the cut-off value of greater than or equal to 290 ng/ml was shown to be efficient (sensitivity 79.5%, specificity 74.4%) in the detection of genital tract inflammation as defined by leukocytospermia (>1x10(6) leukocytes/ml), The prevalence of increased elastase in 292 infertile men was significantly higher (34%) as compared with that (5%) observed in 20 fertile men (P = 0.02), Moreover, high elastase concentration (greater than or equal to 290 ng/ml) was observed in 66 of the 264 men (25%) without leukocytospermia, A significant positive correlation was found between elastase concentration and patient age (r = 0.202, P < 0.0001) and the number of leukocytes (r = 0.330, P < 0.0001), A negative correlation was found between elastase concentration and semen volume (r = -0.146, P = 0.01) and the percentage of spermatozoa with single-stranded DNA (r = -0.194, P = 0.024), but there was no correlation between elastase and sperm reactive oxygen species production. A higher seminal elastase concentration was significantly associated with tubal damage in female partners (P < 0.001), After norfloxacine antibiotic therapy, decrease in elastase concentration was observed in 15 (25%) of the 60 treated patients. Tubal damage in the partner negatively affected the response to antibiotic therapy. In conclusion, granulocyte elastase is a reliable screening test for silent genital tract inflammation of the couple. The elastase-inhibitor complex may have a protective effect in reducing sperm DNA denaturation.