Advice: Haematospermia does not normally require referral unless associated with:
- abnormal DRE
- raised PSA (although PSA may be raised if infection is present)
- abnormal findings in the external genitalia
Refer To: Urologist
Most patients have low-grade seminal tract infection and are best managed using a course of fluroquniolone. It is worth performing urinalysis as a standard test.
In young sexually active men, or those with multiple sexual partners, sexually transmitted infection should be considered.
Semen culture can be performed, but results may be misleading because of contamination by urethral organisms.
The American Association of Family Physicians has produced the following guidelines, which are helpful in deciding management:
1. Men younger than 40 years with limited episodes of hematospermia and no risk factors or associated symptoms can be evaluated for common genitourinary diseases, treated if indicated, and reassured.
2. Men with hematospermia who are 40 years and older, have associated symptoms, or have persistent hematospermia need more extensive evaluation.
3. Low-volume haematospermia associated with iatrogenic aetiologies is often self-limiting; therefore, observation is the most appropriate management strategy.