(304) Post Orgasm Illness Syndrome (POIS)- A Case Series

Introduction Post orgasm illness syndrome (POIS) is a rare condition that causes severe distress, significant morbidity including negative impacts on patients’ sex lives. There are no official diagnostic criteria (or management guidelines) but it is characterised by the following: a rapid onset of flu like fatigue and / or allergy symptoms after ejaculation / orgasm that can last for several days before fully dissipating. It is thought to be a systemic reaction that involves multiple systems: 7 main clusters of symptoms have been described. Its onset can be primary or secondary. The aetiology of POIS is unknown but a number of hypotheses have been proposed including allergic or autoimmune mechanisms, autonomic dysfunction and dysregulated cytokine or neuroendocrine disorders. Despite the unclear aetiology and no known cure, expert opinion does exist for patient care and symptom management. Objective We present the findings of our service evaluation of the management of our patients diagnosed with POIS. Methods Retrospective descriptive case series of 11 patients who were diagnosed with POIS at our sexual function clinic. Results Eleven male patients with post-orgasmic illness syndrome (POIS) were included in this case series. Ethnicities were mixed: four White British, three British Asian, one Arab, one Eritrean, and two unspecified. Three patients (27%) had primary POIS, while eight (73%) presented with secondary POIS. All patients reported more than two clusters of symptoms. Sexual dysfunction was common, with seven patients (64%) experiencing erectile dysfunction, early ejaculation, or reduced libido. Five patients (45%) had a background of atopy, including asthma, allergic rhinitis, or eczema. Semen microscopy, culture and sensitivity testing were performed in nine patients; 5 (56%) were treated for male accessory gland infection (MAGI). Two patient's experienced complete resolution of POIS symptoms following a four-week antibiotic course. All experienced some reduction of symptoms post-treatment. Seven patients (64%) commenced treatment with 180 mg fexofenadine daily, with two reporting complete or near-complete symptom resolution. Two patients used low-dose doxycycline (50 mg daily); one reported prolonged symptomatic improvement but discontinued therapy due to concerns about long-term antibiotic use. Five patients received selective serotonin reuptake inhibitors (SSRIs) without benefit. Four were treated with NSAIDs, only one noted mild improvement of headache symptoms only. Individual patients also reported temporary benefit from L-dopa, calcium D-glucarate, vitamin B6, and norethisterone. Conclusions POIS is a rare disease its true prevalence is unknown, there are increasing numbers of people with symptoms that fit this nascent diagnosis. Its underlying pathophysiology remains uncertain. In this case series, patients with POIS have concomitant sexual dysfunction (including early ejaculation as previously described in the literature) and atopic disorders, the latter supporting a potential immunological predisposition. The observation that some patients experienced complete symptom resolution following antibiotic therapy for MAGI and others improved with antihistamines could suggest that infection and immune-mediated mechanisms may overlap in POIS. Overall, these findings highlight the heterogeneous nature of POIS and the need for increased clinical awareness. Further research is needed to understand the pathogenesis and effective management/s of this rare condition. Disclosure No