Blood in Semen
What should I do if I have blood in my semen?
If you have blood in your semen, you should contact your GP for further advice. Most GPs will perform some simple, baseline tests. You may be commenced on antibiotics or anti-inflammatory drugs to treat presumed infection / inflammation (the commonest cause of blood in the semen). If the symptoms settle, your GP will normally provide reassurance as in most cases there is no worrying underlying cause.
Your GP will refer you to a urologist if there are any abnormalities in the work-up or if the blood in the semen persists.
What are the causes of blood in the semen?
Most patients with blood in the semen have mild inflammation in the prostate, urethra or seminal vesicles, which requires no specific treatment and resolves spontaneously.
Other uncommon causes for blood in the semen are:
low-grade seminal tract / urinary tract infection;
sexually-transmitted infection
blood disorders
recent urological surgery e.g. prostate biopsy
testicular, urethral or prostate cancer (very rare); and
other causes, including less common infections (e,g. tuberculosis)
What investigations are required for blood in the semen?
If the condition improves by itself, you can be reassured that the chance of finding significant pathology is low. If the blood in the semen persists, you will normally prescribe a course of antibiotics or anti-inflammatory drugs.
Further investigations will be necessary if:
your prostate feels abnormal on rectal examination and/or your PSA blood test is abnormal;
examination or ultrasound reveals an abnormal testicle;
there is blood in your urine (visible or invisible); or
you have regular blood in the semen, despite adequate treatment, especially if you are over the age of 45 years.
Your urologist will perform further workup based on your situation
Detailed questioning about your urinary tract and any related symptoms
A physical examination (including rectal & scrotal examination)
Blood tests including PSA
Examination of the urine for infection and cancer cells
Scans such as MRI and / or ultrasound of the prostate / scrotum
Procedures such as cystoscopy (camera examination of the urethra, prostate and bladder)
What treatment is required for blood in the semen?
If your symptoms resolve and no abnormalities are found on history, examination and investigations, then no further treatment in necessary. If any abnormalities are found, your urologist will discuss their treatment with you.