Haematospermia

Abstract

A 40 year old man complains of two episodes when he noticed blood in his ejaculate. He is otherwise well and has no comorbidities.Visible blood in ejaculate-haematospermia or haemospermia-is usually an isolated symptom, and its incidence is unknown. In most cases, it is benign and self limiting, often caused by inflammation or infection of the prostate, urethra, or seminal tract. 1 Possible causes are outlined in Box 1. Patients may describe haematuria, urinary frequency, dysuria, and scrotal, pelvic, or perineal pain, particularly at the time of orgasm. 2 What you should cover HistoryAsk about:• Timing, frequency, and duration of haematospermia, and colour of the semen: bright red with or without clots (that is, fresh bleeding), or brown (old blood).• Associated urinary symptoms suggestive of infection-for example, dysuria, frequency, or urgency of urination, visible haematuria, pain in the abdomen, scrotum, pelvis, or perineum.• Sexual history, including presence of urethral discharge, which could point to a sexually transmitted infection. • Recent urological investigation or intervention.• History of prolonged or excessive bleeding or easy bruising from minor injuries or surgical procedures suggestive of bleeding disorders or a history of coagulopathy.• Travel history, particularly to areas where tuberculosis and schistosomiasis are endemic, as these can cause genitourinary tract infections.• Family history of prostate cancer, particularly in first degree relatives and relatives diagnosed under the age of 60, and coagulopathies. Examination• Ask the patient to expose the external genitalia. Palpate for any lumps, scrotal tenderness, or swelling, which could indicate underlying testicular or epididymal pathology• Perform a digital rectal examination to detect prostatic enlargement, tenderness, fluctuance, firmness, or nodules• Look for signs of easy bruising or bleeding tendencies, such as large bruises (>5 cm in diameter) in the absence of trauma, and petechiae• Examine the abdomen for hepatosplenomegaly, which could indicate an underlying haematological, liver, or infectious disease• Measure blood pressure to identify uncontrolled hypertension What you should doHaematospermia can cause alarm. Reassure patients that a single episode is likely to be benign and self limiting, and ask them to return if the problem continues (Box 2).The initial approach is to rule out infectious causes (Box 1). We suggest that these results are interpreted based on the age of the patient. However, onward referral criteria are based on expert opinion, supported by limited evidence. 3-6 The algorithm ( fig 1⇓) showing the initial assessment and management of haematospermia is based on authors' clinical experience and practice.In patients aged under 40, the most common cause is infection, and management can be guided by non-specialists. Urologists tend to recommend a prolonged course of antibiotics, usually six weeks in duration. Consider referral to a genitourinary medicine clinic if you suspect a sexually transmitted infection to ...

Symptoms and signs of urogenital cancer in primary care

“…This is in accordance with a previous study from Norwegian general practice [ 16 ]. One patient with haematospermia is in line with the acknowledged rare occurrence of this symptom in cancer of the prostate [ 33 ]. In articles from urological groups, the emphasis is commonly on PSA and newer diagnostic markers rather than on symptoms [ 34 ].…”

The diagnosis and management of haematospermia

“…The longer the symptom duration, the higher the risk of malignancy. 1 The type of haematospermia can help refine the diagnosis. Fresh blood indicates a traumatic-type injury while old blood is more often associated with infection.…”

“…The majority of patients, particularly aged <40 years, require reassurance that the condition usually resolves by itself and does not require any further investigation (Figure 1). 1 These patients can be managed in primary care and never need to be seen by a urologist in clinic. Nevertheless, there are certain features that indicate patients do require referral to urology.…”

Hematospermia as a manifestation of severe hypertension in a young man

“…A review of guidelines in the medical literature reveals a focus on urological investigations, such as prostate imaging and biopsy , but rarely recommends measurement of the systemic blood pressure, despite severe uncontrolled hypertension being known to be an etiological factor in hematospermia . This simple, noninvasive test may negate the need for more invasive investigations and identify an otherwise silent cardiovascular pathology that may require urgent treatment.…”