Common causes of Hematospermia (blood in semen) may include (but are not limited to):

– Infections (in the form of urethritis, prostatitis, epididymo-orchitis): chlamydia, gonorrhea, schistosomiasis, HIV, Tuberculosis (TB), etc.

– Tumours: prostate, testicular, and bladder cancers, benign cysts, etc.

– Vascular: varicoceles, hemangiomas, prostatic telangiectasia, etc.

– Systemic diseases: hypertension, bleeding disorders, leukemia, lymphoma, etc.

– Trauma or iatrogenic (e.g. medications, instrumentation)

It is also important to distinguish between true hematospermia vs. other sources of bleeding such as blood in the urine (hematuria) or blood from a sexual partner that you notice during or after sexual intercourse.

The most important part of the initial assessment will be a detailed clinical history and physical examination. Apart from describing your current problem and associated symptoms (e.g. pain passing urine, discharge, etc.), you should also inform your doctor of any past medical or surgical history, recent or regular medications, and family history for conditions like bleeding disorders or malignancy.

We would also ask about any potential sexual exposures or other risk factors for infection. We would then perform a physical examination, checking temperature and blood pressure, and looking in particular for any abnormalities such as tenderness, masses, or enlarged lymph nodes. It is also important to perform a digital prostate examination to look for any tumors or inflammation of the prostate.

Depending on your clinical history and examination, we would then advise on further investigations as appropriate. For instance, blood tests for full blood count, prostate tumor markers, and clotting factors may be needed. It is also common to run an STD urethritis screen for chlamydia, gonorrhea, trichomonas, and other infections (Rapid STD Screening is available in our clinic with next day results).

If there are clinical suspicions for prostate or testicular cancer, you may have to do some imaging tests such as ultrasound, CT or MRI scans.

We must first ensure there is no sexually transmissible infection that is causing the hematospermia.

Chlamydia, gonorrhea, and HIV fall under this category and must be excluded through testing before we can safely say that your partner is not at risk.

If an infection is suspected or proven through testing, then it will be treated with the necessary medications – it would be prudent then for your partner to come for STD testing and STD treatment as well.

Most causes of hematospermia will have no effect on male fertility. Read more about male infertility.

However, some types of testicular cancer can reduce reproductive capacity, and of course, will have to be excluded through appropriate investigations.

If you are concerned about fertility following an episode of hematospermia (blood in semen), semen analysis for fertility parameters can be performed at a later date.

Assuming your initial tests are all unremarkable, and your doctor says there is nothing serious to worry about, it is important to note that it may still take awhile before the ejaculate normalizes completely. At times, it can even take upwards of ten episodes of ejaculation to fully clear the ‘old blood’ that is present in the ejaculatory ducts.

Remember that the great majority of cases of hematospermia are self-resolving and benign. However, if you continue to have recurrent or persistent episodes of fresh blood seen, it may be necessary to get a referral to a urologist who may consider more invasive tests such as transrectal ultrasound, urocystoscopy (camera test) or biopsy.

There is also evidence that a trial of antibiotic therapy may be beneficial in some men, even with negative urine and semen cultures (i.e. no bacteria detected). For older males, it may be prudent to continue with a period of follow up or surveillance blood tests, especially for prostate cancer blood markers (PSA), even in cases where imaging is initially clear.