While exploring the internet for new health perspectives, I ran across a blog post asking, “Could Parasites Be Causing Prostate Cancer?” This post led me to another article by Gustavo Arrizabalaga at the Indiana University School of Medicine. Gustavo’s article stated, “A new study led by graduate student Darrelle Colinot at Indiana University School of Medicine and published in the journal The Prostate may have found yet another cause of inflammation in the prostate — the common parasite Toxoplasma gondii. Inflammation of the prostate is closely associated with benign prostate hyperplasia (BPH) and prostate cancer.” I was fascinated. So, I did some digging and found quite a bit that I thought my health science readers might find interesting. Let’s talk about the unknown prevalence of urogenital parasites.

First of all, kudos to those searching for the cause! Part of me wants to congratulate them for this discovery because I know that roughly 175,000 men in the United States will be diagnosed with prostate cancer this year and because BPH affects 70% of US men 60–69 years of age and 80% of those 70 years of age or older. However, the other side of me feels compelled to share some uncomfortable truths.

We must stop and think long and hard about the potential link between parasites and the prostate. Specifically, and regarding the article in question, we should consider that we are talking about identifying merely one parasite out of so many. I have questions! How common is this parasitic infection? How does one come about getting it? If it can happen with this one parasite, can it happen with others? If it can happen in the prostate, can it happen in other organs? How many of the cases are the result of this one parasite? How many of these men have had this parasite for years? How many partners have these parasites been shared with?

Sure, several papers and studies have asked similar questions regarding urogenital parasites in male reproductive organs. Do such infections exist? Can it really happen? However, the answers to both questions are a resounding “yes!”

Let me provide a few examples to support this claim. In a study published in the Journal of Urology in 2004, researchers analyzed the prostate tissue of men with prostatitis (inflammation of the prostate). They found that 37% of the samples contained urogenital parasites. Another study published in the Journal of Clinical Microbiology in 2008 found that 43% of men with prostatitis had urogenital parasites in their semen. And in a study published in the Indian Journal of Urology in 2010, researchers found that 52% of men with prostate cancer had urogenital parasites in their prostate tissue.

These are just a few examples, but they demonstrate that urogenital parasites can infect the prostate and other male reproductive organs. It is essential for medical practitioners to be aware of this and to consider the possibility of parasitic infections in their diagnoses and treatment plans. Ignoring the possibility of such infections can lead to misdiagnosis and inadequate treatment, potentially resulting in ongoing suffering for the patient.

But don’t tell that to the vast majority of physicians. Most medical practitioners suggest that the occurrence is unlikely or even impossible despite the evidence. However, a quick review of the data demonstrates that it’s not only possible; it’s probable.

A Few Studies that Prove the Point

We’ve already discussed a few studies demonstrating the potential for parasitic infection in reproductive organs. However, we should be aware that quite a few studies demonstrate that urogenital parasites are probably a much bigger issue for men than previously believed. This is important to note because we cannot address a problem unless we are willing to identify a problem.

In the Int. braz j urol. vol.30 no.5 Rio de Janeiro Sept./Oct. 2004, (Print version ISSN 1677-5538, On-line version ISSN 1677-6119), they describe the case of a 32-year-old man who tested normal but had scrotal pain. The left epididymis was inflamed and hardened. They performed a left epididymectomy which resolved the pain. Interestingly, however, was the finding of eggs of the parasite Schistosoma mansoni in the resected epididymis.

In the Am J Trop Med Hyg. 2014 Jul 2; 91(1): 89–91, they describe the case of a 25-year-old healthy man with intermittent bilateral testicular pain and swelling. The biopsies in both testicles revealed the presence of a dead filarial parasite, Wuchereria bancrofti.

Posted on BMJ, in an entry titled “Genital manifestations of tropical diseases, Sexually Transmitted Infections” ( 2004;80:12-17), the researchers talk about genital symptoms caused by protozoal and helminthic infections, which are not usually sexually transmitted. They say that symptoms may mimic classic sexually transmitted infections (STIs) by producing ulceration (for example, amoebiasis, leishmaniasis) or lesions of the upper genital tract (epididymo-orchitis caused by tuberculosis, leprosy, and brucellosis; salpingitis as a result of tuberculosis, amoebiasis, and schistosomiasis).

In Emerg Infect Dis. 2018 Mar; 24(3): 602–603, they suggest that more parasitic infections than what we currently know about might also be transmitted sexually, stating, “Considering that parasitic diseases represent one of the most common infections worldwide, mainly in developing countries, sexual transmission of parasitic diseases could represent a major global problem in terms of public health.” They go on to say that “E. hystolitica has been identified in the testicles, epididymis, and seminal fluid, can reportedly cause infertility as a result of reproductive organ damage, and is transmitted by sexual contact (both oral-anal and oral-genital sexual practices).”

According to Urologia International (Urol Int 2008;81:1–13), the seminal vesicles are often involved in Schistosomiasis infections. Additionally, epididymitis and orchitis can occur and can provide a stricture of the urethra, which may be palpable, simulating Peyronie’s disease. Schistosomiasis infections also present genital skin lesions and obvious alteration in semen color and consistency. Of course, the Abstract says it all. It states, “With the world increasingly becoming a global village, transnational and transcontinental migration has become the order of the day. It is expected that migrants will take with them some diseases (including parasites) which are normally endemic in their countries of origin, to their host countries. Similarly, environmental changes that result from development of water resources, global warming, growth and migration of population can facilitate the spread of parasites. In this review we describe the epidemiology, presentation, diagnosis and treatment options of parasites that urologists may encounter. Notably among these parasites are Schistosoma haematobium, Echinococcus granulosus, Wuchereria bancrofti and Onchocerca volvulus.“

As you can see, the evidence regarding urogenital parasites is clear – and mounting. Of course, these are just a few of the many that I have found. Yes! The possibility exists! It can happen and does happen. So what is the hold-up regarding testing and treatment? Why is it so difficult to diagnose these issues, and why is it so hard for patients to find the doctors and researchers who CAN (or will) help them?

The fact that these infections exist and that researchers continue to find new urogenital parasites previously not believed to be an issue for humans. However, this is all the evidence we need to understand that further research is needed. Of course, I theorize that if we can find one, two, or even five new urogenital parasites that were previously unidentified or thought not to be a problem, then there are likely quite a few more that we need to be on the lookout for.

The Undiagnosed Sufferers

Doctors tend to recognize that a virus or bacteria can spread across the globe due to our globalized society. However, they still believe that your chances of a parasitic infection remain low if you have not traveled abroad. This is insanity, or at the very least, highly illogical.

Chronic prostatitis, epididymitis, orchitis, and urinary issues plague many men. Unfortunately, many of these cases go undiagnosed or are thought to be psychosomatic, as standard tests cannot identify the culprit. This is often despite the patient having clear symptoms ranging from pain and swelling to the discoloration of semen.

Most doctors are unaware of the potential for these types of urogenital parasitic infections because they were taught that such infections were impossible. The problem is that most doctors will not look for or test for something they believe cannot be there. Something has to change!

However, even if doctors did believe a parasitic infection existed, most of them are not equipped to search for it because the technology is not readily available to them or because they do not know what technology is needed, as they were not trained on it. There is a clear gap here. Even urology clinics do not have a way to test for many of these parasites or eggs. As a result, medical science has almost entirely missed parasites that infect male reproductive organs. The point is that it is extremely difficult to diagnose or treat something you are not equipped to find or simply will not look for.

Meanwhile, countless men continue to suffer, many in silence. I have been shocked at the number of men who have contacted me through this website, looking for help on a variety of issues, and all because their doctors have given up. This is a problem on so many levels. The big question is just how widespread the problem really is.

Tests are Still Limited & Lacking

Observations alone are not enough to accurately diagnose many parasitic infections. Many patients simply do not know they carry them. Moreover, many patients have reported that when they present doctors with pictures of the artifacts found in their semen, doctors often dismiss them as contaminants. This is despite the fact that these artifacts have been found repeatedly in numerous samples over an extended period of time. Patients have few options for proving to their doctors (who are often unwilling to examine the samples themselves) that the infection is real. The irony is that patients should not have to prove such things to their doctors in the first place.

Testing for most parasites is limited to standardized tests like the O&P or simple observations. The problem with observations is that most doctors do not have their own microscopes, and standardized tests are not designed to detect parasites that are thought to be incapable of causing infection. This is especially true when the location of the infection is not within the specialty of the chosen doctor. Even if it were, the chances of detecting a parasite by the time it is suspected are low. A paper from Front Immunol. 2017 states that “helminths have evolved to become experts at subverting immune surveillance. Through potent and persistent immune tempering, helminths can remain undetected in human tissues for decades.“

Research from J Parasitol Res. 2012 confirms this, stating that “many protozoa cause infections that often follow chronic courses, owing to coevolution between parasites and the host immune system. The survival and transmission of pathogenic protozoa depends on their ability to evade or subvert the host’s innate and adaptive immune responses. A great challenge to research in immunology and parasitology is the development of strategies that favor immunity against protozoan parasites and prevent their evasion, chronic, or recurrent infections and associated pathologies.“

So basically, parasites learn how to trick the immune system. This means that an appropriate immune response may not always be present, rendering many current tests inadequate. And now we’ve come full circle because doctors are reluctant to explore the possibilities despite the obvious potential.

The Future Is Not Quite Here

Undoubtedly, further research is needed to fully understand the link between parasites and the prostate. It is clear that current testing methods are not sufficient, and there is a lack of awareness among medical professionals about the possibility of such infections. This lack of awareness and inadequate testing can lead to patients being misdiagnosed or not receiving proper treatment for their condition. It is essential that more research is conducted in this area and that medical professionals are educated about the potential for parasitic infections in the prostate and other reproductive organs. Only then will we be able to accurately diagnose and effectively treat these infections and improve the health and well-being of those affected.

That said, I do feel that progress is being made, and such techniques are probably getting close. In fact, an entry titled “Next-Generation Sequencing of Infectious Pathogens” provides some amazing insights regarding such progress. However, there is another problem to consider. Much of the focus has been on the prostate alone, but conditions like orchitis, epididymitis, etc., are still neglected.

Some of the studies reviewed suggest that when parasites are suspected, the fluid appears normal. Are the Cowper’s glands and the Glands of Littre unaffected by certain urogenital parasites? We do know that artifacts are found in the ejaculate specifically. This may also suggest that it is possible for the infection to be located near or in the testicle itself, even though the fluids produced by these other glands make up a significant portion of the total volume of semen. All we need to do is look at other animals in nature. It seems anything is possible – even if it is rare.

Now We See. Now What?

The questions surrounding parasites in male reproductive organs are valid and deserve much more attention. I believe that the topic of urogenital parasites has been overlooked by medical science and is vastly understudied and highly misunderstood. Something needs to be done, and clearly, more research is needed.

We should start by asking ourselves some basic questions. Given what we know now, should we revisit these “unknown” causes of epididymitis and orchitis? What tests or procedures would help identify specific urogenital parasites in semen? What procedures or protocols might isolate a potential parasite seen through common microscopes in a semen sample? At the very least, which research labs are equipped and willing to examine such samples and objectively report the findings?

It seems entirely illogical to see evidence of an issue and deny its possibility, whether it is rare or not. Furthermore, it is equally illogical to see the evidence of an issue and refuse to explore it. This subject needs competent doctors and researchers. New protocols for examining and testing these parasites need to be drafted.

Given the sheer number of men dealing with undiagnosed or unknown sources of reproductive/urological pain and suffering, it seems that the time for action has come. This is especially true in light of the evidence that suggests that a larger problem may be at play. Doctors need to become proficient in examining samples through a microscope, and new tests should be developed (or made more readily available) to help narrow down the culprits.

It’s rather simple. If these men can acquire a parasitic infection that has gone undiagnosed, then it is quite possible that these infections are spreading in ways we currently do not understand. Only through exploration will we gain understanding. The research here has demonstrated that this is not only possible but is likely the reality. So, what now?

And with all that being said, it is important to note that it is understood that a good portion of these urogenital issues is likely caused by normally innocuous bacteria or viruses acting in a pathogenic way. This article is not meant to ignore or diminish the importance or need for exploration, identification, and treatment of such infections, which are also largely and unnecessarily ignored. Instead, I wanted to highlight a clear gap that should be considered in practice. Across the board, we can see an issue regardless of the offending pathogen.

It is important to consider the potential impact of parasites on the reproductive system and overall human health. More research is needed to fully understand the link between parasites and the urogenital tract and the prevalence and potential consequences of such infections. It is also important to consider other potential factors that could contribute to such issues, such as diet, lifestyle, and genetics.

You might also enjoy my article titled Parasites – Listen To Your Body

“If patients suspect a rare disorder that is undiagnosed by their physicians, actively pursuing self-diagnosis using the internet can be successful.”

Dr. Anthony J. Bleyer, MD, Professor of Nephrology at Wake Forest

Dr. Robertson is a health researcher and educator, not a physician. The information provided here is not medical advice, a professional diagnosis, opinion, treatment, or service to you or any other individual. The information provided is for educational and anecdotal purposes only and is not a substitute for medical or professional care. You should not use the information in place of a visit, call consultation, or the advice of your physician or other healthcare providers. Dr. Robertson is not liable or responsible for any advice, course of treatment, diagnosis, or additional information, services, or product you obtain or utilize. IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY, YOU SHOULD IMMEDIATELY CALL 911 OR YOUR PHYSICIAN.