What is the treatment for hematospermia?

Treatment of Hematospermia

The treatment of hematospermia should be guided by patient age, persistence of symptoms, and associated clinical findings, with most cases requiring only reassurance and observation as they are typically benign and self-limiting. 1

Age-Based Management Algorithm

For Men Under 40 Years with Transient/Episodic Hematospermia

• No imaging or extensive workup is needed for young men with isolated, transient episodes and no other symptoms 1, 2
• Management includes:
  • Reassurance about benign nature (most important intervention)
  • Watchful waiting
  • Routine clinical evaluation 1

For Men 40 Years or Older OR Any Age with Persistent Hematospermia OR Associated Symptoms

• Diagnostic evaluation is recommended before treatment 1

• Initial workup:

  • Prostate-specific antigen (PSA) testing 1, 2
  • Thorough prostate examination 2
  • Urinalysis and urine culture 2
  • STI testing if sexually active 2, 3
  • Blood pressure measurement 4

• Imaging studies:

  • Transrectal ultrasound (TRUS) - first-line imaging modality (rated 8/9 for appropriateness) 1
  • MRI pelvis - if TRUS is negative or inconclusive (rated 7-8/9 for appropriateness) 1
  • CT and angiography are not recommended (rated 1-2/9) 1

Cause-Specific Treatment

1. Infectious/Inflammatory Causes (Most Common in Men <40)

• Antibiotic therapy for confirmed bacterial infections 3
• Common regimens:
  • Fluoroquinolones (e.g., ciprofloxacin)
  • Doxycycline for suspected chlamydia/mycoplasma
  • Duration typically 2-4 weeks 3, 5

2. Ejaculatory Duct Obstruction

• Identified by TRUS showing:
  • Dilated seminal vesicles
  • Midline cysts
  • Calcifications 1
• Treatment: Transurethral resection of ejaculatory ducts if symptomatic 5

3. Prostatic Causes

• For prostatic inflammation:
  • Anti-inflammatory medications
  • Alpha-blockers for associated voiding symptoms 5
• For prostatic calculi or cysts identified on imaging:
  • Surgical intervention if symptomatic and persistent 3

4. Vascular Abnormalities

• Rare cases may require:
  • Selective arterial embolization for identified arterial bleeding sources 1
  • This is reserved for intractable cases when other evaluations have failed 1

5. Systemic Conditions

• Control of hypertension if present 4
• Correction of coagulation disorders if identified 4

Special Considerations

• Iatrogenic hematospermia (post-prostate biopsy) typically resolves spontaneously within 3-4 weeks 4
• Persistent or recurrent hematospermia despite initial management warrants referral to urology 6
• Malignancy is rare but should be excluded in men >40 years with persistent symptoms 2

Pitfalls to Avoid

• Don't over-investigate young men with isolated episodes - this can increase anxiety and is rarely productive 2
• Don't ignore persistent or recurrent hematospermia, especially in men >40 years 6
• Don't miss associated symptoms that may indicate more serious pathology:
  • Fever/chills
  • Weight loss
  • Bone pain
  • Lower urinary tract symptoms 2

Follow-up Recommendations

• For self-limited cases: no specific follow-up needed
• For treated infectious causes: repeat semen analysis after completion of therapy
• For persistent cases: follow-up with urology and consideration of additional imaging or cystoscopy 5

Remember that despite being alarming to patients, hematospermia is usually benign, and reassurance is often the most important aspect of management.