Gross hemospermia refers to the presence of visible blood in the ejaculate. Microscopic hemospermia refers to the presence of blood on microscopic examination.
Possible causes of hemospermia:
(1) hypertension
(2) vascular disorder, including venous stasis
(3) congenital malformation
(4) infections
(4a) prostatitis
(4b) sexually transmitted diseases
(4c) tuberculosis
(4d) schistosomiasis
(5) calculus disease in prostate or seminal vesicles
(6) malignant tumor
(7) idiopathic
The evaluation may include:
(1) semen analysis, especially the presence of inflammatory cells (pyospermia)
(2) cystoscopy
(3) transrectal ultrasound (TRUS)
(4) imaging studies such as CT scan and/or MRI
(5) culture and evaluation for sexually transmitted disease
(6) needle biopsy
(7) serial serum PSA measurement
(8) urinalysis with microscopic examination of the urine sediment
(9) PPD
(10) blood pressure monitoring
Factors which may determine how far to carry the evaluation:
(1) duration (lifelong vs recent onset)
(2) age, especially > 40 years of age
(3) weight loss, pain or systemic findings
