Blood in Semen: Is This Serious?

Introduction

Finding blood in the semen fluid can be a frightening and troubling symptom in most men. This is a condition known as haematospermia. This can occur during or after ejaculation. While blood in semen can be a benign condition and may resolve spontaneously, it may signify an underlying health alert such as inflammation, infection or even more concerning pathological conditions such as malignancy of the urogenital tract.

We would like to increase awareness of such symptom and encourage men to seek medical assistance and early evaluation of the presenting symptoms rather than 'leave it alone' for self-resolution. 

Background Anatomy

The sperm is produced in the testes and travels through the epididymis, vas deferens and ejaculatory duct. During the ejaculation process, the accessory organs such as seminal vesicles, prostate and Cowper’s glands produces seminal fluid to be mixed with sperm and expulsed out of the body through the urethra. In order for haematospermia to occur, one must have a normal ejaculatory function.

What causes blood in the semen?

The common causes of blood in semen can be categorized into

In younger male, blood in the semen is often a result of infection or inflammation. As age progresses, the risk of developing cancer increases. Hence in older person who presents with blood in semen, it is imperative to exclude sinister pathologies such as tumor or malignancies over the urogenital tract. Blood can be present in semen following prolonged abstinence from sex or repetitive/excessive sex and masturbation.

What are the types of STDs that can result in blood in the semen?

Common STD urogenital infections that are responsible in blood in semen in sexually active men include: 

• Chlamydia trachomatis
• Neisseria Gonorrhea
• Herpes Simplex Virus
• Syphilis (Treponema Pallidum)
• Ureaplasma spp
• Mycoplasma spp
• Trichomoniasis
• Cytomegalovirus

Blood in semen secondary to underlying STDs can be transmissible to your sexual partner(s) if the infection is unresolved. 

What should I do with blood in semen?

You should consult your doctor if you see any blood in your semen.

In particular, if your symptoms of haemtospermia is associated with other risk factors:

• The occurrence of blood in semen is more than once
• The symptoms is associated with unintentional weight loss
• Associated painful ejaculation
• You have a blood clotting disorder
• You have history of urogenital/ pelvis trauma
• You have or family history of prostate/ testicular cancer
• You are 40 years and above

What do I expect my doctor to do?

Your doctor will want to understand your symptoms and associated symptoms from your history. This will be followed up with a physical examination involving examination of your genitals, rectal examination, basic checks of your blood pressure. 

Depending on individual risk and symptoms, your doctor may offer you further tests to evaluate for infection or inflammation. Imaging tests in the form of ultrasound or MRI of the prostate, and testicle maybe offered to evaluate underlying structural cause. 

In some cases, specialist urologist input may be necessary as well. Urologist may offer a procedure known as cystoscopy to envisage and evaluate the inner urethra and bladder by inserting a flexible sterile camera tube into the urethra.

What are the treatments for blood in the semen?

Treatment of blood in semen will be based on underlying cause. Often, blood in semen can be benign, and resolve on its own, and no treatment is warranted.

In infection, one will be prescribed antibiotics to eradicate the underlying infection(s).

In those with enlarged prostate, your doctor may offer medication or surgery to alleviate the symptoms.

Specialist urologist input may be required if concern was underlying structural abnormalities. In cases of malignancies and cancer, multi-disciplinary medical team involving surgery, radio-/chemotherapy, immune therapy may be offered depending on individual cases.

Afterwords..

• Most patients consult their doctor following blood in semen due to the alarming nature of the presenting symptom. While most cases of hematospermia are self-resolving and benign, it is important not to miss major diagnosis including infections and malignancies. 
• Majority of urogenital infections are treatable medically with good prognosis. Delay or missed in treating infection can result in persistent blood in semen or even further complication such as chronic pain, scarring or infertility.
• Urogenital malignancies should be screened, diagnosed and managed early to minimized health morbidities and mortalities. 

At Dr Ben Medical, our doctors provide confidential men’s health and urogenital evaluations tailored to individual symptoms and risk factors.

References:

1. Mathers MJ, Degener S, Sperling H, Roth S. Hematospermia-a Symptom With Many Possible Causes. Dtsch Arztebl Int. 2017 Mar 17;114(11):186-191.
2. Suh Y, Gandhi J, Joshi G, Lee MY, Weissbart SJ, Smith NL, Joshi G, Khan SA. Etiologic classification, evaluation, and management of hematospermia. Transl Androl Urol. 2017 Oct;6(5):959-972
3. Ambakederemo TE, Dodiyi-Manuel ST, Ebuenyi ID. Bloody semen, severe hypertension and a worried man. Pan Afr Med J. 2015 Apr 6;20:326.
4. Fuse H, Komiya A, Nozaki T, Watanabe A. Hematospermia: etiology, diagnosis, and treatment. Reprod Med Biol. 2011 May 10;10(3):153-159.