Editors

JukkaSairanen

Haematospermia

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

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 Chlamydial Urethritis and Cervicitis, 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)

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.

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]