From the Guidelines
Hematospermia evaluation should begin with a thorough history and physical examination, focusing on duration, associated symptoms, and risk factors, as most cases are benign and self-limiting, with malignancy being rare (<2% of cases) 1.
Initial Evaluation
The initial evaluation of hematospermia should include:
- A detailed history to determine the origin of bleeding within the ejaculate
- Physical examination to identify any underlying conditions
- Laboratory testing, such as:
- Visual analysis of the ejaculate for red discoloration
- Microbiological testing
- Semen analysis
- Urinalysis
- Urine culture
- Assessment of serum coagulation
- Serum chemistry panel
- Complete blood count 1
Risk Stratification
Men can be stratified into different risk categories based on their age and symptoms:
- Men under 40 with isolated, self-limited episodes and no risk factors: reassurance is appropriate, as 90% of cases resolve spontaneously within several weeks 1
- Men over 40, or those with persistent hematospermia (>1 month), recurrent episodes, or concerning features (pain, lower urinary tract symptoms, risk factors for prostate cancer): further evaluation is warranted 1
Further Evaluation and Treatment
Further evaluation may include:
- Urinalysis
- Urine culture
- STI testing
- PSA (in men >40)
- Possibly transrectal ultrasound (TRUS) or MRI pelvis with and without IV contrast 1 First-line treatment addresses underlying causes, such as:
- Antibiotics (e.g., doxycycline 100mg twice daily for 2-4 weeks) for suspected infection
- Anti-inflammatory medications for inflammation
- Treatment of any identified urological conditions 1
Referral to Urology
Persistent or concerning cases may require referral to urology for specialized evaluation, including cystoscopy or MRI 1
From the Research
Evaluation of Hematospermia
- Hematospermia can be a distressing symptom for patients, but most cases are effectively managed by a primary care physician 2.
- The condition is usually benign, but significant underlying pathology must be excluded by history, physical examination, laboratory evaluation, and other diagnostic modalities 2, 3.
- In men younger than 40 years without risk factors, hematospermia is often self-limited and requires no further evaluation or treatment other than patient reassurance 2, 4.
Diagnostic Approach
- A thorough evaluation is warranted to rule out more serious pathology and address patient anxiety 3, 5.
- The diagnostic approach includes:
- Patient history and physical examination 4, 5
- Laboratory tests, such as urinalysis and testing for sexually transmitted infections 2, 4
- Transrectal ultrasonography, magnetic resonance imaging, and urethrocystoscopy in select cases 4, 6
- Digital rectal palpation and prostate-specific antigen testing to evaluate for prostate cancer in men 40 years and older 2, 4
Treatment
- Treatment for hematospermia depends on the underlying pathological lesions 4, 5.
- Hematospermia caused by genitourinary infections is effectively treated with appropriate antiviral, antibiotic, or antiparasitic agents 4.
- Hematospermia due to malignant disorders resolves with definitive treatment of the primary lesions 4.
- In many cases, treatment involves only minimal examinations and simple reassurance 4, 6.