Haematospermia

Essentials

• Haematospermia is usually an innocent symptom with no identifiable specific cause.

Aetiology

• Urological interventions are the most common cause: prostate biopsy (in up to 80% of the patients), vasectomy
• Urethral trauma, e.g. in association with sexual activity
• Prostatitis or prostatovesiculitis Chronic Prostatitis
• Sexually transmitted diseases: chlamydia , gonorrhoea , herpes
• Blood coagulation disorders , 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 needs no other treatment than reassuring the patient. Haematospermia may occur in 2 months after prostate biopsies or vasectomy.

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]