What is the treatment for hematospermia?

Treatment for Hematospermia

The treatment for hematospermia should be guided by the underlying cause, with most cases being benign and self-limiting, requiring only reassurance and no specific intervention, especially in men under 40 years of age with a single episode and no other symptoms. 1

Diagnostic Approach Based on Patient Characteristics

Men Under 40 Years with Transient/Single Episode

• No imaging or extensive workup needed if:
  • Single/transient episode
  • No other symptoms
  • No risk factors (cancer history, urogenital malformations, bleeding disorders)
• Management: Reassurance that condition is likely benign and self-limiting 1, 2

Men Under 40 Years with Associated Symptoms

• Basic workup:
  • Urinalysis
  • STI testing
  • Assessment for urogenital infections (most common cause in this age group) 1, 2
• Management: Treat identified infections with appropriate antibiotics

Men 40 Years and Older OR Any Age with Persistent/Recurrent Hematospermia

• Recommended imaging:
  • Transrectal ultrasound (TRUS) - rated 8/9 for appropriateness 1
  • MRI pelvis without and with IV contrast (if TRUS negative/inconclusive) - rated 8/9 1
• Additional testing:
  • Prostate-specific antigen (PSA) testing
  • Digital rectal examination
  • Urinalysis and urine culture 1, 2

Treatment Based on Etiology

Infectious/Inflammatory Causes (40% of cases)

• Treatment: Appropriate antibiotics based on culture results
• Common organisms: Chlamydia, gonorrhea, E. coli, other urinary tract pathogens 3

Iatrogenic Causes

• Post-prostate biopsy: Most common cause in men over 40
  • Management: Reassurance as this typically resolves within 3-4 weeks 4

Prostatic/Seminal Vesicle Pathology

• Calcifications/calculi:
  • Treatment: TRUS-guided aspiration or transurethral procedures for symptomatic cases 1
• Cysts:
  • Treatment: Drainage if symptomatic 5

Vascular Abnormalities

• Severe/intractable cases:
  • Treatment: Consider pelvic angiography with potential transcatheter arterial embolization 1

Systemic Causes

• Hypertension:
  • Treatment: Blood pressure control 4
• Bleeding disorders:
  • Treatment: Address underlying coagulopathy 2

Important Considerations

When to Refer to Specialist

• Men over 40 years with persistent hematospermia
• Recurrent episodes despite treatment
• Associated symptoms (fever, weight loss, bone pain)
• Abnormal findings on initial evaluation

Medication Considerations

• Finasteride: Note that hematospermia is reported as a rare postmarketing adverse event 6
• This medication should not be used to treat hematospermia unless specifically indicated for BPH

Pitfalls to Avoid

1. Over-investigation in young men with single episodes
2. Under-investigation in men over 40 or with persistent symptoms
3. Failure to screen for prostate cancer in men over 40
4. Missing systemic causes like hypertension or bleeding disorders
5. Confusing partner's blood with true hematospermia (important to clarify during history)

Follow-up Recommendations

• Single episode that resolves: No follow-up needed for men under 40
• Recurrent episodes: Re-evaluation with TRUS or MRI if not previously performed
• After treatment of identified cause: Follow-up to confirm resolution

Remember that while hematospermia is anxiety-provoking for patients, it is rarely associated with serious pathology, especially in younger men. Appropriate reassurance is an important part of management.