Haematospermia

Usually self-limiting problem, with infection being the most common cause.

History

  • Timing, frequency, duration, fresh or old blood
  • Risk factors for STI
  • Symptoms of UTI
  • Recent urological investigations/interventions
  • Anything to suggest bleeding probs
  • Travel history – TB and schistosomiasis can cause UTIs
  • Family history of prostate cancer (esp <60 ys) and of coagulopathies

Examination

  • Testicles/epididymes for swelling
  • DRE for prostate lumps
  • BP for uncontrolled hypertension
  • Abdo for hepatosplenomegaly (underlying probs)

Investigations

  • Semen and urine for M, C & S
  • FBC/clotting screen
  • PSA in >40s

Referral if multiple episodes or >40

If single episode in <40-yr-old, and nil found on above, can simply reassure and leave – to present again if further episodes.

(Not clear what counts as ‘further episodes’. If persists for >10 episodes, evaluate further.)

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About Dr Sarah

I'm a GP with a husband and two young children.
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