From the Guidelines
Hematospermia typically resolves on its own without specific treatment, as it's usually benign and self-limiting. For persistent cases, treatment depends on the underlying cause, with infections being the most common etiology, accounting for approximately 40% of cases overall 1.
Treatment Options
- If infection is suspected, antibiotics such as doxycycline (100mg twice daily for 7-14 days), ciprofloxacin (500mg twice daily for 7-14 days), or trimethoprim-sulfamethoxazole (160/800mg twice daily for 7-14 days) may be prescribed.
- For inflammation, anti-inflammatory medications like ibuprofen (400-600mg three times daily) can help reduce symptoms.
- Patients with prostate involvement might benefit from alpha-blockers such as tamsulosin (0.4mg daily).
Diagnostic Evaluation
Reassurance is important as most cases resolve within several weeks to months without complications. Patients should abstain from ejaculation for a few days if the condition causes discomfort. For recurrent or persistent hematospermia, especially in men over 40, further evaluation with urinalysis, PSA testing, or imaging may be necessary to rule out more serious conditions like tumors or vascular abnormalities 1.
Imaging
Noninvasive imaging, predominantly transrectal ultrasound (TRUS) and MRI, can be used in men of any age with persistent or refractory HS, or other associated symptoms or signs. TRUS is considered as the first-line imaging with MRI used when TRUS is inconclusive or negative 1.
From the Research
Treatment for Hematospermia
The treatment for hematospermia depends on the underlying cause of the condition.
- In many cases, hematospermia is self-limiting and requires no further evaluation or treatment other than patient reassurance 2, 3.
- For men younger than 40 years without risk factors, hematospermia is often benign and requires no further evaluation or treatment 2.
- In cases where hematospermia is caused by genitourinary infections, treatment with appropriate antiviral, antibiotic, or antiparasitic agents is effective 3.
- For men 40 years and older, or those with persistent or recurrent hematospermia, further investigation is necessary to exclude urogenital malignant disorders 2, 3.
- Treatment for hematospermia due to malignant disorders, including prostate, testis, and seminal vesicle cancers, involves definitive treatment of the primary lesions 3.
- In some cases, transrectal ultrasonography, magnetic resonance imaging, urethrocystoscopy, and histological confirmation by biopsy may be necessary to diagnose and treat the underlying cause of hematospermia 3, 4.
Evaluation and Diagnosis
A complete history and physical examination, laboratory testing, and imaging modalities can help identify and treat the underlying pathology promptly 5, 4.
- Patient history, physical examination, laboratory tests, transrectal ultrasound examination of the prostate, MRI, CT, and cystoscopy are important for correct diagnosis 6.
- The extent of evaluation and treatment depends on the patient's age, the duration and recurrence of hematospermia, and the presence of any associated hematuria 6.