REMEDY : BNSSG referral pathways


Checked: 06-11-2017 by Rob.Adams Next Review: 05-11-2018

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.

Examination and investigation should include:

Blood pressure check to exclude uncontrolled hypertension.

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.

CKS (web page) also has some advice on how to investigate and when to refer.


(1) Hemospermia. The Journal of Urology. May 2007.Volume 177, pages 1613-1618

Referral Guidance

Local urologists advice is that isolated haematospermia cannot be due to anything sinister. 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



Red Flags

If investigation in primary care indicates suspected malignancy then please refer via 2WW.

See Urology 2WW guidelines

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)