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JukkaSairanen

Haematospermia

Essentials

  • Haematospermia is usually an innocent symptom and does not require urgent further investigations.

Aetiology

  • Haematospermia is usually idiopathic and no specific underlying cause can be found.
  • Urological interventions: prostate biopsy (in up to 80% of the patients), vasectomy
    • Haematospermia may occur in 2 months after prostate biopsies.
  • Urethral trauma, e.g. in association with sexual activity
  • Prostatitis or prostatovesiculitis Chronic Prostatitis
  • Sexually transmitted diseases: chlamydia Chlamydia, gonorrhoea Gonorrhoea, herpes Genital Herpes
  • Schistosomiasis (ethnic background, travel history) Schistosomiasis (Bilharziasis)
  • Blood coagulation disorders Assessment and Treatment of a Patient with Bleeding Diathesis, anticoagulation therapy
  • Rarely a tumour in the prostate Prostate Cancer or elsewhere along the urinary tract (virtually almost never in men less than 50 years of age), benign urethral haemangiomas (also rare)

Investigations

  • For investigations into possible haematuria, see Haematuria.
  • Palpation of the prostate (touch per rectum) to detect a tumour
  • Samples to detect STDs are taken according to patient history or if there are signs of urethritis
  • Travel history: long-term haematospermia may be a symptom of schistosomiasis.
  • Semen analysis can be performed if there is uncertainty whether the patient really has haematospermia or if schistosomiasis is suspected.
  • Repeated haematospermia is an indication for further investigations (plasma prostate-specific antigen, ultrasonography of the prostate, cystoscopy), particularly in men above 50 years of age.

Treatment

  • Non-specific haematospermia does not need treatment.
  • Treatment of an underlying cause, e.g. infection

    References

    • Ahmad I, Krishna NS. Hemospermia. J Urol 2007 May;177(5):1613-8. [PubMed]
    • Manoharan M, Ayyathurai R, Nieder AM, Soloway MS. Hemospermia following transrectal ultrasound-guided prostate biopsy: a prospective study. Prostate Cancer Prostatic Dis 2007;10(3):283-7. [PubMed]
    • Schwartz E, Pick N, Shazberg G, Potasman I. Hematospermia due to schistosome infection in travelers: diagnostic and treatment challenges. Clin Infect Dis 2002 Dec 1;35(11):1420-4. [PubMed]