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 Haematospermia ( Hematospermia in US ) or Hemospermia 
is presence of blood in ejaculate

Self limiting in most case but alarming for patients and provokes anxiety Most men with HS are young ( < 40 yrs ) & it mat occur as a single episode or repeatedly over time Incidence is difficult to predict as
○ men usually do not check semen & may go unnoticed ( ie covert presentation )
○ patient embarrassment
○ self-limiting nature Most common causes are
○ infection ( usually in people < 40 )
○ iatrogenic – less common now ( better imaging etc ) Most cases can be managed in primary care HS may be associated with pathology of

Causes- Urethritis , prostatitis , epididymitis Genito-Urinary TB CMV , HIV Schistosimiasis , hydatid Urinary tract infection Condylomata of urethra & meatus Systemic causes -Uncontrolled hypertension Bleeding disorders Lymphoma Leukaemia Chronic infections as
○ TB
○ Schistosomiasis
○ Amyloidosis ( rare ) Haemophilia Purpura Scurvy Liver cirrhosis Tumours- Prostate Bladder Seminal vesicle Urethra Testis- epididymis Melanoma

History-Age of patient ,timing , frequency , how long R/O pseudo-haematospermia ie blood coming from patients partner , intense sexual behaviour Colour of semen
○ bright red without clots suggests fresh bleeding
○ brown – older blood Associated symptoms
○ UTI linked →dysuria , frequency , urgency
Ask about haematuria → follow haematuria pathway if present
Pain in abdomen , scrotum, , pelvis or perineum
○ Prostatitis linked → pain on ejaculation 
 BPH → check symptoms suggestive of BPH or prostate cancer
 Family h/o prostate cancer
○ STI linked – urethral discharge
○ Trauma or instrumentation in urogenital region
○ Bleeding disorder or coagulopathy , anticoagulant use Constitutional symptoms 
○ weight loss
○ loss of appetite
○ bone pain Travel hx- areas where TB or Schistosomiasis are common

Examination-BP- check for uncontrolled hypertension Examine testes , penile urethra DRE to check prostate ( mandatory ) Examine abdomen Look for signs of easy bruising or bleeding tendencies ( eg skin ) Send MSU ( all ) PSA in men > 40 yrs
CKS recommends PSA testing in men of any age with signs and symptoms or a family h/o Prostate cancer Consider
○ Coagulation screen
○ Renal and LFTs

Referral –Men over 40 with no identifiable cause Men with suspected prostate cancer and/or abnormal PSA Men or boys with suspected testicular or urological cancer Presentation at any age with more than 10 episodes and no identifiable cause Suspected cyst or calculi of prostate or seminal vesicles Episodes continue despite treatment Concurrent haematuria Systemic cause suspected

Summary-Self limiting in most cases it is most common between ages 30-40 yrs Persistent cases are more likely to be due to an underlying serious pathology Management depends on underlying cause If infection suspected or proven use antimicrobials- suggested ( Dantanarayana )
○ ceftriaxone IM or oral azithromycin for suspected STIs
○ trimethoprim or augmentin for prostatitis or epididymo orchitis
○ young men persistent idiopathic HS- one month of Doxycyline If no cause found following primary and secondary care investigations and episodes continue to be troublesome – one option is 5 -alpha reductase inhibitors
○ particularly in elderly patients with benign prostatic bleeding
○ explain that it may take up to 6 months before symptoms improve

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