Haematospermia

GGC - Primary Care
NHS GGC

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Haematospermia assessment

  • History: Associated haematuria, anticoagulant use, UTI/STI symptoms
  • Examination: DRE and genital, BP
  • Investigation: PSA (especially if ≥45 years), urinalysis +/- MSSU, extra tests dependent on other findings (coag, US)

Red flag symptoms present

  • Age ≥45 years with abnormal PSA1
  • Recurrent episodes of haematospermia despite treatment and ≥45 years1
  • Abnormal prostate findings during PR exam at any age1
  • Abnormal testis on examination or US assessment1
  • Other symptoms, including painless haematuria, unintentional weight loss, anorexia, unexplained lethargy, unexplained lower back or bone pain

No red flag symptoms advice

  • Episode(s) of haematospermia with no other symptoms:1
  • Reassurance – normally a focal area of inflammation in the prostate resulting in blood in the ejaculate (70% of seminal fluid is from the prostate)1

Simple management advice

Treat accordingly if:

  • Suspected genitourinary tract infection (UTI, STI)
  • Treat any associated hypertension
  • If recurrent, treat as suspected prostatitis with 4–8-week course of antibiotics and/or NSAIDs1

Not improving/no change/next steps

Refer to Urology if haematospermia is persistent despite treatment

Criteria for secondary referral to Urology

  • Males of any age with red flag symptoms (USOC)1
  • Males ≥45 years who have recurrent or persistent haematospermia despite treatment (Urgent)1

Abbreviations

  • BP, blood pressure
  • DRE, digital rectal examination
  • MSSU, midstream specimen of urine
  • NSAID, non-steroidal anti-inflammatory drug
  • PSA, prostate-specific antigen
  • STI, sexually transmitted infection
  • US, ultrasound; USOC, urgent suspicion of cancer
  • UTI, urinary tract infection
  • PR, rectal examination

References

  1. British Association of Urological Surgeons (BAUS). Blood in the semen (haematospermia). September 2024. Available at: www.baus.org.uk/patients/conditions/1/blood_in_the_semen_haematospermia (Accessed: January 2025)
  2. CfSD. Scottish Referral Guidelines for Suspected Cancer 2024 Full Clinical Review (Draft). December 2024.

Editorial Information

Last reviewed: 12/08/2025

Next review date: 30/06/2026

Author(s): Consultant Urologist.

Version: 1

Approved By: Urology South and North Sector