Background:
A 34 year old married male presented with recurrent episodes of fresh bleeding in semen during ejaculation that was also seen on undergarments on waking up over the past three years. He was treated elsewhere with antibiotics before.
He had no H/O trauma, drugs, high risk sexual exposure or past urinary infections.
Management:
He was anxious about recurrent episodes of the above phenomenon interspersed with coffee coloured semen in quiescent stages.
Clinical examination revealed normal external genitalia and rectal examining was non-revealing of any pathology. Urine evaluation was negative. Semen evaluation confirmed gross heamatospermia.
TRUS (Transrectal Ultrasonography) showed evidence of seminal vesiculitis with normal prostate.
He was treated with a combination of Quinolone antibiotics and Finasteride as an attempt to complete eradication of the inflammation of the seminal vesicles and to decrease the incidental gross vascularity that goes on with this clinical condition especially in a protracted case as this. Finasteride was continued for four months and then withdrawn. The patient has completely recovered without any fresh episodes since last seen a year ago.
Discussion:
Haematospermia is the visible presence of blood - red colour when fresh to dark or altered when the bleeding is remote - in the semen. The most common age group that presents is under 40 years, young sexually active male and the most common cause of the same is non-specific inflammation of 'prostate and seminal vesicles' – which are the accessory sexual organs involved in the passage of the semen.
This entity brings in its wake lots of anxiety and distress in a young male and is difficult to treat, being refractory if not completely cured as in above case till it is presented to a Uro-Andrologist.
In a small subset of cases haematospermia heralds a hidden presence of malignancy in the sexual organs - testes, prostate and seminal vesicles. Few cases of genito urinary tuberculosis do present symptoms in a similar manner. Sexually transmitted infections also bring about urethral and urinary symptoms in its wake.
The entity is treatable completely and requires TRUS for the evaluation of the Prostate-Seminal Vesicle complex; however, in some suspicious cases MRI with rectal coils helps in arriving at a cryptic diagnosis.
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