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Haematospermia

Checked: 23-02-2019 by Rob Adams Next Review: 23-02-2020

Principles of Management

Men who present with haematospermia are often anxious about the cause and GPs can be uncertain about how to investigate and who or when to refer. With modern diagnostics the proportion of patients diagnosed with idiopathic haematospermia has decreased. The dilemma now is how far to investigate these patients since in the majority it is a benign and self-limiting condition. (1)

In men younger than 40 years of age, the most common cause of haematospermia is infection and this should be excluded.

In men 40 years old and older, an underlying malignancy should be excluded and this can usually be done in primary care.

Examination and investigation in all ages should include:

Ask about visible haematuria and manage appropriately if this is also present.
Check blood pressure to exclude uncontrolled hypertension.
Examine testes to exclude lumps, tenderness or swelling. Refer for USS of testes if any concerns (see the USS requesting guidelines for details of justified USS requests agreed for BNSSG).
DRE to assess the prostate.
Urinalysis to exclude urinary infection.
Sexually transmitted infection screen.
Bloods to include PSA in all men 40 and over and in younger men with family history of prostate cancer (once infection excluded).
Also consider coagulation screen, UE and LFT if symptoms are persistent or clotting disorder suspected.

CKS (web page) also has some advice on how to investigate and when to refer but please note local advice below which suggests that referral is rarely indicated if above investigations are normal.

If investigations above are normal then reassurance is usually all that is required. The cause is usually rupture of a vessel in the prostate or seminal vesicles and this will almost always settle without further intervention.

If symptoms persist for more than 3 months then a referral can be considered.

(1) Hemospermia. The Journal of Urology. May 2007.Volume 177, pages 1613-1618

Referral Guidance

Local urology consulant and GPSI advice is that isolated haematospermia cannot be due to anything sinister and if the investigations above are normal then referral to secondary care for haematospermia is therefore rarely indicated.

If you need further reassurance or advice then clinicians should refer to urology clinic via eRS (the urology A and G service have requested that referrers do not use their service for this indication).

Red Flags

If investigation in primary care indicates suspected malignancy then please refer via 2WW.

See Urology 2WW guidelines

Haematospermia after prostate biopsy

Reassure men who have has a recent prostate procedure that any associated haematospermia should resolve within three to four weeks. (CKS)

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

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