Q:

8/10/2012
I saw a 22 year old woman with the classic symptoms of seminal fluid allergy with local swelling and burning starting 3-5 minutes after exposure (no such symptoms if her partner wears a condom) followed by 2 days of painful intercourse. This began soon one week after her first encounter with this partner, with whom she began having sex two months ago. She had a previous partner for 3 years without such symptoms. Before that she had a few sexual encounters without symptoms.

I have read all the information on Ask the Expert and on Medline about this topic. The patient did her own "skin test" by applying the ejaculate on her arm and scratching it with a sterilized needle and the result was positive (erythema, swelling and pruritis)!

My questions are:
1. Should I test her? Must I let the specimen liquefy then centrifuge or can I use the specimen without this preparation and must I 'filter sterilize it', which I do not have the capability of doing in my office?
2. Should I test her partner for HIV, syphilis and hepatitis?
3. Does this mean she will have this problem with all subsequent partners?
4. Should I test her partner to control for irritant responses?
5. If it is negative are there other tests I can do (serum etc...) or must I assume that it is a false negative and that the proteins in the sample are not present in sufficient concentration to elicit a positive response?
6. Is there any more data about cross reactivity with dog allergens?

As always, I appreciate your expertise.

A:

Thank you for your inquiry.

As you know from reading previous responses to “Ask the Expert” questions regarding seminal fluid allergy, Dr. Jonathan Bernstein is an internationally recognized expert in this disorder. He has published extensively in this area, and therefore I am asking Dr. Bernstein to respond to your inquiry. When we receive his response, we will forward it to you.

Thank you again for your inquiry.

Sincerely,
Phil Lieberman, M.D.

We received a response from Dr. Jonathan Bernstein. Thank you again for your inquiry and we hope this response is helpful to you.

Sincerely,
Phil Lieberman, M.D.

Response from Dr. Jonathan Bernstein:
 
In response to your questions:
1) I would test her by PST to whole seminal fluid. This requires letting the ejaculate liquefy for 30min and centrifuge for 10 minutes to separate Seminal fluid from spermatozoa. I would also test her sexual partner as a negative control. You do not have to sterilize the seminal fluid for prick testing. Intracutaneous testing to whole seminal fluid should not be performed as it will cause an irritant response.
 
2) Both the patient and her sexual partner should be screened for STD's.
 
3) Previously she had no problem with other men. This is variable. Some women have trouble with all men whereas other have symptoms with only one.
 
4) For localized seminal plasma hypersensitivity, skin testing is not always concordant with serologic testing. I have been offering patients the opportunity to send their serum and their sexual partner's serum and a 5 day pooled ejaculate to our laboratory to test for sIgE to whole seminal plasma.  

5) There is no additional recent information about cross reactivity between dog allergens and seminal plasma. In our experience with our patients we have not found there to be cross reactivity with dog allergen and PSA.
 
6) We are recommending that patients with localized seminal plasma hypersensitivity first undergo intravaginal graded challenge; dilute whole seminal fluid with sterile water to 1:100,000 dilution and instill 10 cc of volume intravaginally every 10-15 minutes up to a `1:1 dilution to see if this alleviates symptoms. There are reported cases that this may be effective. If not then she may be a candidate for subcutaneous desensitization to relevant fractionated seminal plasma proteins.
 
Jonathan Bernstein, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology