II. Epidemiology
- Age under 40 years old most common
III. Causes: Common
- Behavioral
- Excessive masturbation
- Rigorous sexual intercourse
- Prolonged sexual abstinence
- Infectious (40% of cases)
- Epididymitis
- Prostatitis
- Rare case reports of Echinococcus, Tuberculosis, schistosoma
- Urinary Tract Infection pathogens have also been implicated
- Sexually Transmitted Disease
- Chlamydia
- Gonorrhea
- HSV I and II Urethritis
- Urethral HPV
- Structural causes
-
Trauma
- Prostate, Urethral, penile or even Hemorrhoidal procedures (esp. Prostate biopsy)
IV. Causes: Uncommon
- Genitourinary Tumors (e.g. Bladder Cancer, Prostate Cancer, Testicular Cancer)
- Prostatic stones, polyps, or cysts
- Urethral Strictures or fistula
- Bleeding Disorders
- Vascular lesions or AV Malformations (e.g. ProstateVarices)
- Uncontrolled Severe Hypertension
V. Risk Factors: More serious underlying Hematospermia cause
- Age over 40 years
- History of cancer or significant cancer risk
- Known urologic structural abnormality
- Bleeding Disorder
- Trauma
VI. History
- Number of episodes and exacerbating factors (e.g. intercourse)
- STD exposure
- Systemic symptoms (fever, weight loss, Night Sweats)
- Bleeding Disorder
- Pain
- Dysuria
- Painful Bladder Distention
- Cystitis
- Painful ejaculation
- Prostatitis
- Ejaculatory duct obstruction
- Voiding difficulty (double voiding, hesitancy, decreased stream)
- Benign Prostatic Hyperplasia (BPH)
- Bladder neck obstruction
- Urethral Stricture
- Cystitis
VII. Exam
- Vital Signs (Temperature, Blood Pressure, Heart Rate)
- Complete genitourinary exam
- Include inguinal Lymph Node exam
- Testicular Mass
- Epididymitis findings
- Signs of Genitourinary Trauma including at Urethral meatus
- Rectal Exam with Prostate exam
VIII. Labs
- Urinalysis and Urine Culture
- Prostate Specific Antigen (PSA) in age over 40 years old
- Sexually Transmitted Disease tests
- Additional labs to consider for persistent or recurrent symptoms or risk factors as above
- Coagulation studies (PT/INR, PTT, Complete Blood Count)
- Urine cytology
IX. Differential Diagnosis
X. Management: Urology referral indications
- Recurrent or persistent high volume Hematospermia
- Hematospermia with unexplained genitourinary pain or voiding difficulty
- Abnormal history, exam, labs or suspected structural abnormality
XI. Management: Empiric therapy trials
- Observation without treatment
- Anticipate resolution within 2-3 weeks and with 10 or more ejaculations
- Consider two weeks of empiric Antibiotics for Epididymitis or Prostatitis
- Trimethoprim-Sulfamethoxazole
- Doxycycline
- Ciprofloxacin or Levaquin
- Consider alpha blocker trial of 4-6 weeks if Benign Prostatic Hyperplasia (BPH) suspected
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Definition (NCI) | A finding indicating the presence of blood in the semen. |
Definition (MSH) | Blood in the SEMEN, usually due to INFLAMMATION of the PROSTATE, the SEMINAL VESICLES, or both. |
Concepts | Finding (T033) |
MSH | D051516 |
ICD9 | 608.82 |
ICD10 | R36.1 |
SnomedCT | 34615008, 198061004, 198078008, 155940003 |
English | HAEMOSPERMIA, HEMOSPERMIA, Haematospermia, Bloody semen, blood in semen, blood in sperm, hematospermia (diagnosis), hematospermia, hematospermia (symptom), blood in the semen, Hemospermia [Disease/Finding], blood ejaculation, haemospermia, hemospermia, ejaculation blood, Haemospermia (disorder), Haemospermia, Hemospermia (finding), Hematospermia, Hemospermia, haematospermia, Blood (in);semen |
Dutch | hemospermie, bloederig semen, hematospermie |
French | Sperme sanguinolant, HEMOSPERMIE, Hématospermie, Hémospermie |
German | Haemospermia, blutiges Sperma, Haemospermatismus, HAEMOSPERMIE, Haematospermie, Hämatospermie, Hämospermie |
Italian | Presenza di sangue in liquido seminale, Ematospermia, Emospermia |
Portuguese | Sémen sanguinolento, HEMOSPERMIA, Hematospernia, Hematospermia, Hemospermia |
Spanish | Semen sanguinolento, HEMOSPERMIA, Hemospermia, hematospermia (hallazgo), hematospermia, Hematospermia |
Swedish | Hemospermi |
Japanese | ケツセイエキショウ, 血精液症 |
Czech | hemospermie, Hematospermie, Hemospermie, Krvavé semeno |
Finnish | Siemennesteen verisyys |
Russian | GEMOSPERMIIA, ГЕМОСПЕРМИЯ |
Polish | Hemospermia |
Hungarian | Hematospermia, Hemospermia, Haematospermia, Haemospermia, Véres ondó |
Norwegian | Hematospermi, Blod i sæden |