Principles of Management
Men who present with haematospermia are often anxious about the cause and GPs can be uncertain about how to investigate and who or when to refer. With modern diagnostics the proportion of patients diagnosed with idiopathic haematospermia has decreased. The dilemma now is how far to investigate these patients since in the majority it is a benign and self-limiting condition. (1)
In men younger than 40 years of age, the most common cause of haematospermia is infection and this should be excluded.
In men 40 years old and older, an underlying malignancy should be excluded and this can usually be done in primary care.
Examination and investigation in all ages should include:
- Ask about visible haematuria and manage appropriately if this is also present.
- Check blood pressure to exclude uncontrolled hypertension.
- Examine testes to exclude lumps, tenderness or swelling. Refer for USS of testes if any concerns.
- DRE to assess the prostate.
- Urinalysis to exclude urinary infection.
- Sexually transmitted infection screen.
- Bloods to include PSA in all men 40 and over and in younger men with family history of prostate cancer (once infection excluded).
- Also consider coagulation screen, UE and LFT if symptoms are persistent or clotting disorder suspected.
CKS (web page) also has some advice on how to investigate and when to refer but please note local advice below which suggests that referral is rarely indicated if above investigations are normal.
If investigations above are normal then reassurance is usually all that is required. The cause is usually rupture of a vessel in the prostate or seminal vesicles and that almost always the problem will settle.
(1) Hemospermia. The Journal of Urology. May 2007.Volume 177, pages 1613-1618
Local urology consulant and GPSI advice is that isolated haematospermia cannot be due to anything sinister and if the investigations above are normal then referral to secondary care for haematospermia is therefore rarely indicated.
If you need further reassurance or advice then clinicians should consider using the Urology Advice and Guidance service
If investigation in primary care indicates suspected malignancy then please refer via 2WW.
Haematospermia after prostate biopsy
Reassure men who have has a recent prostate procedure that any associated haematospermia should resolve within three to four weeks. (CKS)