Key messages
Cough, runny nose and a rash are usually unpleasant; in rare cases, they can also be embarrassing. Because cold viruses or an allergy to grass Co. are not always the causative «villains», as the medical history of a 27-year-old patient shows, which the US urologist Dr. Andrew Shanholtzer and his colleagues from the William Beaumont Hospital in Royal Oak in Michigan report.
The patient and his story
The young man presented himself at the clinic on Royal Oak because he repeatedly developed symptoms such as cough, runny nose and an envelope on his forearms after ejaculate.He also noticed swollen lymph nodes on his neck. The patient believed that his symptoms had begun around nine years earlier after acute epididymitis. Symptoms occurred regardless of whether ejaculation was through masturbation or sexual intercourse. Because of the symptoms, the young man avoided any sexual activity or romantic relationships.Before his introduction, he had already visited several doctors, including an allergist who had been diagnosed with hay fever. However, several ultrasound examinations of the scrotum were inconspicuous, also a sperm analysis and testosterone levels were normal.
Therapy and course
The diagnosis of the US doctors was post-orgasmic illness syndrome (POIS); for therapy, they initially recommended diphenhydramine. Since this antihistamine did not help, urologists prescribed fexofenadine at a dosage of 180 mg daily; According to the patient, this therapy was so successful that he dared to become sexually active again.
Discussion
POIS is increasingly recognized as a cause of sexual dysfunction in men; nevertheless, this disorder is not familiar to most doctors, the US authors report.The result could be a large number of doctor visits and examinations. Men who are affected by it show cold-like symptoms that appear about 30 to 60 minutes after ejaculation. For example, some men feel feverish, tired or exhausted. Others feel that their nasal mucous membranes swell, breathing becomes difficult or their eyes itch. Symptoms usually last two to seven days.
The exact etiology of POIS is unclear. It is generally believed that symptoms are due to type I and IV allergic reactions to autologous sperm. Although sperm are potentially immunogenic due to the blood-testicular barrier and genetic differences compared to their own DNA, POIS can affect even men who are sterilized; this suggests, according to the US urologists, that if an immune reaction is the cause, the antigen is likely found in the seminal fluid and not in the sperm itself.
POIS is a rarely diagnosed disease; there is no therapy backed up by large randomized and controlled trials.What there are are isolated reports of therapy trials with different agents, including selective serotonin reuptake inhibitors, benzodiazepines and also immunotherapeutics. In addition, attempts were made to desensitize by injection of diluted autologous seminal fluid. According to US doctors, this treatment is an attractive option; however, it is costly and requires frequent visits to the practice. A patient with POIS and low normal testosterone was successfully treated with human chorionic gonadotropin . In her patient, the most effective treatment was the daily intake of fexofenadine, which is better tolerated with regular intake and works longer than diphenhydramine.
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