RAG rating: n/a
Document type: Clinical pathways
Place: South and West Hertfordshire
Output type: Clinical Pathways
Pathway: Haematospermia Pathway

Haematospermia

Pathway Publish Date: October 2024

Pathway Next Review Date: October 2026

Normally a benign self limiting condition:
• Measure BP and perform testicular exam
• Urine dip stick (check for haematuria)
• Send Mid Stream Urine to lab for all patients

To exclude Identifiable Causes:
• Consider DRE and other physical examination

• Consider referral for STI screening

• Consider PSA in men at >40yr after 4 weeks (repeat in further 6 weeks if raised on initial test)

• Consider FBC, UE, LFT, Coag screen

Identifiable Causes Common:

• Infection - UTI or STI

• Trauma or instrumentation (such as prostatic biopsy) – reassure him that symptoms normally settle within 3-4 weeks.

Less common:

• Suspected prostatitis (patient may have pelvic pain)

• Oral Anti Coagulants • Suspected benign prostatic hypertrophy – refer to male LUTS guidance

Rare:

• Prostate cancer

• Testicular cancer

• An acquired bleeding disorder (secondary to suspected haematological cancer, or liver or kidney failure) – refer for further assessment to the appropriate specialist.

• TB/Schistosomiasis (take traveler history)

Suspected Cancer pathway if persistently raised PSA, suspicious DRE (see PSA pathway or signs of urological cancer)

No identifiable cause; Age > 40 more than 3 episodes within 1 month - Routine Electronic Urology Referral for appointment.

Age < 40, less than 3 episodes within 1 month, Reassure: Advise to return if more than three episodes within a 1 month period.

Please see pathway attached.

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