The Approach to Conception for Women with Seminal Plasma Protein Hypersensitivity
American Journal of Reproductive Immunology VOL. 52; APRIL 2004

Allergic reactions to human seminal plasma protein has become increasingly recognized in the medical community.Tre atment for most allergic conditions usually begins with avoidance of the offending allergen.For women with seminal plasma protein hypersensitivity (SPH) who desire to conceive, this approach is unacceptable.We describe a case report of a woman with an SPH who desired to have unprotected intercourse in order to conceive.

Is Burning Semen Syndrome a Variant Form of Seminal Plasma Hypersensitivity?

Since returning from the Gulf War region, some veterans and/or their female sexual partners have reported burning, pain, and swelling of the urogenital tract after exposure to semen. This phenomenon referred to as the “burning semen syndrome” is similar to symptoms experienced by women in the general population with localized and/or systemic seminal plasma hypersensitivity. 1,2 Women with localized seminal plasma hypersensitivity experience vaginal inflammation manifested clinically as burning and pain, which occurs within minutes after contact with their sexual partner’s semen. Criteria for diagnosis of seminal plasma hypersensitivity include relief of symptoms with the use of a condom in association with the presence of specific immunoglobulin (Ig) E antibody to one or more seminal plasma protein antigens and the absence of an underlying medical disorder that could cause symptoms similar to seminal plasma hypersensitivity. Rapid desensitization using relevant homologous seminal plasma protein antigens obtained from their sexual partner’s ejaculate has been effective.1,3,4 Response to desensitization suggests that some of these postcoital localized vaginal reactions may be IgE mediated.1–3 A questionnaire survey previously distributed to 1073 women in the general population who suspected they might have symptoms consistent with localized and/or systemic seminal plasma hypersensitivity revealed that 12% fulfilled the diagnostic criteria for one or both of these disorders.5 This survey indicated that seminal plasma hypersensitivity reactions in women in the general population might be more common than previously recognized.5 However, the prevalence of seminal plasma hypersensitivity and burning semen syndrome among veterans deployed in the Gulf War theater of operations is currently unknown. The primary objective of this study was to determine whether burning semen syndrome manifested by Gulf War couples was similar or different than localized seminal plasma hypersensitivity previously reported in women in the general population.

Prevalence of human seminal plasma hypersensitivity among symptomatic women

Experience with human seminal plasma hypersensitivity in the last decade has led to increased physician awareness of symptoms consistent with human seminal plasma sensitization in women. Incidence and prevalence of human seminal plasma hypersensitivity in women are unknown.

Evaluation and treatment of localized vaginal immunoglobulin E-mediated hypersensitivity to human seminal plasma.
OBSTETRICS & GYNECOLOGY 82:667-73; October 1993

Localized vaginal inflammation after contact with seminal plasma has been previously described but without a clear understanding of the underlying immunopathogenesis. The purpose of this report is to describe three women who presented with localized postcoital vaginal reactions that were successfully treated with rapid immunotherapy using human seminal plasma proteins. CASES: One atopic and two nonatopic women with histories of immediate onset of localized postcoital vaginal symptoms and immediate skin test reactions to human seminal plasma were treated with rapid immunotherapy using their spouse's purified seminal plasma protein fractions. One of the women had decreased cutaneous reactivity post-therapy and detectable circulating specific immunoglobulin (Ig) G and IgE antibodies to her spouse's fractionated seminal plasma proteins. Increased IgG, IgE, and IgA antibodies were found in these patients' sera to whole seminal plasma of a normal male control and to fractionated proteins of different men, indicating that one or more homologous seminal plasma proteins may be responsible for these reactions. Their localized vaginal symptoms resolved completely after rapid immunotherapy treatment. Two of the women have remained symptom-free, whereas the third woman had recurrent localized vaginal symptoms after failing to maintain frequent sexual intercourse after treatment. CONCLUSIONS: Rapid immunotherapy immediately alleviated vaginal reactions to seminal plasma in all patients. These cases indicate that the pathogenesis of some localized vaginal inflammatory reactions may involve IgE-mediated or other immune responses to human seminal plasma proteins.

Selective desensitization to seminal plasma protein fractions after immunotherapy for postcoital anaphylaxis

A 24-year-old white woman reported sexual intercourse-related pruritus, hives, wheezing, and dyspnea within 5 minutes after ejaculation. Systemic reactions (SRs) were prevented by use of condoms. Prick testing confirmed sensitization to five Sephadex G-lOO-separated fractions of her husband's seminal plasma. The intradermal end point threshold concentrations (ETC) were 10 -4 and 10 -j txg of protein per milliliter to fractions 2 and 3, respectively. Leukocyte histamine release studies exhibited 100% release to fraction 2 and 37% release to fraction 3. A 2-day protocol of rapid immunotherapy (IT) was performed with subcutaneous incremental doses of human seminal plasma (HuSePl) fractions 2 and 3. The patient experienced an SR after receiving a cumulative dose of 38.55 Ixg of fraction 2 on day 1. On day 2, rapid IT with fraction 2 was administered until the patient experienced a mild SR after having received a cumulative dose of 102.8 Ixg. There was a one-log~o increase in the intradermal ETC to both fractions 2 and 3 at the end of day 2. IT was continued three times weekly for 4 months until the patient tolerated 100 Ixg doses of both fractions 2 and 3. At 4 months, coitus was resumed without SRs, and HuSePI IT was stopped. The intradermal ETC to fractions 1, 3, 4, and 5 was increased 6 months after cessation of HuSePl injections, but there was a one-log decrease in the ETC to fraction 2. Our experience demonstrated that systemic tolerance can be achieved by parenteral administration of selected HuSePl fractions. Partial immunologic desensitization of patients with anaphylactic sensitivity can be achieved. This appears to be selective for most, but not all, allergenic fractions contained in HuSeP1. ( J ALLERGY CLIN IMMUNOL 1990;86: 954-60.)