Haematospermia is an alarming symptom, but rarely associated with malignancy and most patients can be reassured, particularly for an isolated episode in younger men. STIs and infection needs to be considered, and a full history and examination are required. Rarely, haematospermia can be associated with urological cancers in older men. Uncontrolled hypertension is cited as another cause. There is often no cause found. Consideration can be given to treat empirically for prostatitis if recurrent episodes within a short timeframe (see Prostatitis – RefHelp).
D.M & H.S 18/2/26
Who to refer:
- Abnormal DRE or PSA (refer as urgent suspected cancer)
- If other symptoms are present in addition to haematospermia see appropriate RefHelp pages (eg Haematuria VISIBLE – RefHelp , Recurrent UTIs – RefHelp, Prostatitis – RefHelp , Sexually Transmitted Infections (STIs) – RefHelp )
- If recurrent episodes, consider treating as prostatitis with empirical antibiotics, if not settling and further help required, please refer to Urology as “advice only”.
Who not to refer:
No abnormal tests
Single ‘episode’ of haematospermia
Recurrent “episodes” that settle with empirical antibiotics
How to refer:
SCI Gateway to Urology at the Western General Hospital
For those with abnormal DRE or PSA refer as urgent suspicion of cancer
WGH > urology > LI Prostate disease
For those with recurrent episodes, that do not settle with antibiotics: WGH > Urology > advice only
