Blood in the semen, called hematospermia, is blood that is either too small to be seen (microscopic) or visible in the ejaculation fluid.
For men under age 40, infection is the most common cause. Infection is usually accompanied by other signs and symptoms, such as fever, genital or urinary pain, difficulty urinating, or blood in your urine.
For men age 40 and older, blood in semen is a slight predictor of a cancer (malignancy), most often prostate cancer. So a more careful evaluation is merited when this sign appears in this age group. But the risk is low. In follow-up studies of more than 800 men who had blood in their semen, cancer was found in less than 4 percent (on average).
Symptoms that may occur with this condition include:
Blood in urine
Fever or chills
Lower back pain
Pain with bowel movement
Pain with ejaculation
Pain with urination
Swelling in scrotum
Swelling or tenderness in groin area
Tenderness in the scrotum
More common causes of blood in semen:
Brachytherapy
Chlamydia
Epididymitis
Genital herpes
Gonorrhea
Interrupted sex
Prolonged sexual abstinence
Prostate biopsy
Prostate gland enlargement
Prostatitis
Seminal vesiculitis
Testicular trauma
Vasectomy: An effective form of male birth control
Vigorous sex
Less common causes:
Amyloidosis
Benign growths (cysts, polyps) in the bladder, urethra or prostate
Bladder cancer
Fragile blood vessels
Hemophilia
Prostate cancer
Schistosomiasis
Testicular cancer
Thrombocytopenia (low platelet count)
Tuberculosis
Von Willebrand disease
Warfarin side effects: Watch for interactions
Epididymitis is an inflammation of the coiled tube (epididymis) at the back of the testicle that stores and carries sperm. Although males of any age can develop epididymitis, it occurs most frequently between ages of 20 to 39. When it develops in children, it is usually due to inflammation caused by trauma. However, some children develop it because of bacterial infections, some of which may be due to sexual abuse.
What are epididymitis causes?
The cause of epididymitis is usually a bacterial infection. The bacteria usually get to the epididymis by moving back through (retrograde) the urethra, prostate, vas deferens into the epididymis. The responsible bacteria are usually identified in about 80% of cases.
Two main groups of organisms cause most cases of epididymitis: sexually transmitted organisms and coliforms (organisms that commonly live in the intestines).
- In men younger than about 39 years of age, the causes are usually the same organisms that cause the sexually transmitted diseases of chlamydia (responsible for nearly 50%-60% of cases) and gonorrhea. The bacterial species are Chlamydia trachomatis and Neisseria gonorrhea, respectively.
- In those older than 39 years of age, the causes are usually coliforms, which are bacteria (such as Escherichia coli) that live in the intestines. These organisms also frequently cause bladder infections. Any age of men who participate in anal intercourse are more likely to get infected with E. coli or other fecal bacteria. Epididymitis is rarely caused by fungi or Mycobacterium spp.
- Chemical epididymitis (rare) is inflammation caused by the retrograde (backward) flow of urine when exercising or having sex with a full bladder.
- Amiodarone (Nexterone), a frequently used heart medication, occasionally causes inflammation of the epididymis.
- Viral infections (including mumps), mainly in the pediatric population.
Epididymitis symptoms depend on the cause. They can include:
- A tender, swollen, red or warm scrotum
- Testicle pain and tenderness, usually on one side — the pain may get worse when you have a bowel movement
- Painful urination or an urgent or frequent need to urinate
- Painful intercourse or ejaculation
- Chills and a fever
- A lump on the testicle
- Enlarged lymph nodes in the groin (inguinal nodes)
- Pain or discomfort in the lower abdomen or pelvic area
- Discharge from the penis
- Blood in the semen
Chronic epididymitis
Signs and symptoms of epididymitis usually develop over a day or two and get better with treatment. In some cases, epididymitis may not clear up completely or may recur. This is known as chronic epididymitis. Symptoms of chronic epididymitis may come on gradually. Sometimes the cause of chronic epididymitis is not identified.
Your doctor will do a physical exam, which may reveal enlarged lymph nodes in your groin and an enlarged testicle on the affected side. Your doctor also may do a rectal examination to check for prostate enlargement or tenderness and order blood and urine tests to check for infection and other abnormalities.
Other tests your doctor might order include:
Sexually transmitted infection (STI) screening. This involves obtaining a sample of discharge from your urethra. Your doctor may insert a narrow swab into the end of your penis to obtain the sample, which is then tested for the presence of bacteria or other infectious organisms. The results can be used to select the most effective antibiotic for treatment.
Ultrasound imaging. This noninvasive test uses high-frequency sound waves to create images of structures inside your body and is used to rule out conditions, such as twisting of the spermatic cord (testicular torsion) or a testicular tumor. Your doctor may use this test if your symptoms began with sudden, severe pain and other tests have not been definitive.
Nuclear scan of the testicles. Also used to rule out testicular torsion, this test involves injecting trace amounts of radioactive material into your bloodstream. Special cameras then can detect areas in your testicles that receive less blood flow, indicating torsion, or more blood flow, supporting the diagnosis of epididymitis.
The health care practitioner likely will treat the individual with antibiotics through an IV, a shot, or pills orally (to be taken for 10 days or longer). Often the treatment depends on the identity of the infecting bacteria; many physicians elect to treat with at least two different antibiotics because individuals are occasionally infected with more than one organism.
For men younger than 39 years of age, Ceftriaxone, Azithromycin, and Doxycycline are often prescribed. For men older than 39 years od age or those who participate in anal intercourse, Ciprofloxacin, Ofloxacin, Sulfamethoxazole and trimethoprim are often prescribed.
The CDC guidelines recommend that for acute epididymitis most likely caused by enteric organisms or with negative gonococcal culture or PCR nucleic acid amplification test the following:
Ofloxacin (Floxin) 300 mg orally twice a day for 10 days or levofloxacin 500 mg orally once daily for 10 days.
Guidelines change frequently; most health care practitioners who treat epididymitis are aware of these guidelines, and depending on local resistance patterns of pathogens, may change the type and duration of antibiotics to best fit the patient's condition. Pediatric treatments are best administered by pediatricians and are usually based on the weight of the patient and the infecting organism's antibiotic susceptibility. If the infection is not treated early, complications may develop that require surgery.
For patients with non-infectious causes of epididymitis (for example, chemical, inflammation) anti-inflammatory medication is often prescribed; occasionally, consultation with a urologist is recommended for additional treatments.
What is prostatitis?
Prostatitis is the inflammation of the prostate gland, a walnut-sized gland located directly below the bladder in men. Common size of prostatitis is 432, men with larger size may have a bigger gland. The prostate gland produces fluid (semen) that nourishes and transports sperm. Prostatitis often causes painful or difficult urination. Other symptoms of prostatitis include pain in the groin, pelvic area or genitals, and sometimes, flu-like symptoms.
What are prostatitis types?
There are four types of prostatitis:
Acute bacterial prostatitis is a bacterial infection of the prostate gland that requires urgent medical treatment. It is the least common of the four types and its potentially life-threatening. Fortunately, it is the easiest to diagnose and treat effectively.
Chronic bacterial prostatitis is a bacterial infection that occurs repeatedly, it occurs when bacteria find a spot on the prostate where they can survive. Treatment with antimicrobials do not always cure this condition.
Chronic nonbacterial prostatitis is the most common form of prostatitis. It may be found in men of any age. Its symptoms go away and then returns without warning, and it may be inflammatory or noninflammatory.
Chronis prostate pain syndrome(CPPS) is the diagnose given when the patient does not complain of pain or discomfort but has infection-fighting cells in his prostate fluid and semen. It usually is found in prostate cancer tests.
What are prostatitis causes?
Bacterial infections cause only about 5%-10% of cases of prostatitis. In the other 90%-95%, due to chronic pelvic pain syndrome or asymptomatic inflammatory prostatitis described above, the cause is not known. Prostate infectious agents are as follows for both acute and chronic infectious prostatitis:
- Escherichia coli (E coli) is the bacterium most often the cause of prostate infections and approximately 80% of the bacterial pathogens are gram-negative organisms (for example, Escherichia coli, Enterobacter, Serratia, Pseudomonas, Enterococcus, and Proteus species).
- Sexually transmitted disease-causing organisms also may cause infectious prostatitis especially in sexually active men under 35 years of age; the most usually identified organisms are Chlamydia, Neisseria, Trichomonas, and Ureaplasma.
- Rarely staphylococcal and streptococcal organisms have been found to be the cause, and infrequently different organisms such as fungi, genital viruses, and parasites have been implicated.
- The infectious agent (usually bacteria) may invade the prostate in two main ways.
The bacteria from a previous urethral infection move through prostatic ducts into the prostate (occasionally termed retrograde infection).
- Movement of infected urine into the glandular prostate tissue can infect via ejaculatory ducts (occasionally termed antegrade infection).
Infectious organisms, as previously stated, cause two of the four main types of prostatitis; acute infectious prostatitis and chronic infectious prostatitis.
You are at higher risk for getting prostatitis if you:
- Recently have had a medical instrument, such as a urinary catheter (a soft, lubricated tube used to drain urine from the bladder) inserted during a medical procedure
- Engage in rectal intercourse
- Have an abnormal urinary tract
- Have had a recent bladder infection
- Have an enlarged prostate
What are prostatitis symptoms?
Prostatitis can cause many symptoms, including the following:
- Difficult or painful urination
- Frequent/urgent urination
- Fever
- Low-back pain
- Pain in the penis, testicles or perineum (the area between the testicles and the anus)
- Pain with/after ejaculation
- Inability to get an erection
- Decreased interest in sex
How is prostatitis diagnosed?
Diagnosing prostatitis involves ruling out other conditions that may be causing your symptoms and determining what kind of prostatitis you have. Diagnosis may include the following:
Questions from your doctor. Your doctor will want to know about your medical history and your symptoms. You may be asked to fill out a questionnaire that can help your doctor make a diagnosis and see whether treatment is working.
Physical examination. Your doctor will examine your abdomen and genitals and will likely preform a digital rectal examination (DRE). During a digital rectal exam, your doctor will gently insert a lubricated, gloved finger into your rectum. Your doctor will be able to feel the surface of the prostate and judge whether it is enlarged, tender or inflamed.
Blood culture. This test is used to see whether there are signs of infection in your blood.
Urine and semen test. Your doctor may want to examine samples of your urine or semen for signs of infection. In some cases, the doctor may take a series of samples before, during and after massaging your prostate with a lubricated, gloved finger.
Examination with a viewing scope (cystoscopy). Your doctor may use an instrument called a cystoscope to examine the urethra and bladder. A cystoscope is a small tube with a light and magnifying lens or camera that's inserted through the urethra and into the bladder. This test is used to rule out other conditions that could be causing your symptoms.
Bladder tests (urodynamic tests). Your doctor may order one or more of these tests, which are used to check how well you can empty your bladder. This can help your doctor understand how much prostatitis is affecting your ability to urinate.
How is prostatitis treated?
Treatments vary among urologists and are tailored to the type of prostatitis you have. Correct diagnosis is crucial and treatments vary. It's important to make sure your symptoms are not caused by urethritis (inflammation of the urethra) or some other condition that may lead to permanent bladder or kidney damage.
Treatments can include:
- Anti-inflammatory medicines along with warm sitz baths (sitting in two to three inches of warm water). This is the most conservative treatment for chronic prostatitis.
- Antibiotic medicine for infectious prostatitis. These drugs are not effective treatments for noninfectious prostatitis. For acute infectious prostatitis, patients usually need to take antibiotic medicine for 14 days. Almost all acute infections can be cured with this treatment.
- For chronic infectious prostatitis, antibiotic medicine is taken for a longer period of time, usually four to 12 weeks. About 75% of all cases of chronic infectious prostatitis clear up with this treatment. For cases that don't, taking antibiotics at a low dose for a long time may be recommended to relieve the symptoms.
- Alpha blockers. These medications help relax the bladder neck and the muscle fibers where your prostate joins your bladder. This treatment may lessen symptoms, such as painful urination. Examples include tamsulosin (Flomax), terazosin (Hytrin), alfuzosin (Uroxatral) and doxazosin (Cardura). Common side effects include headaches and a decrease in blood pressure.
- Pain medications.
- Muscle relaxants.
- Surgical removal of the infected portions of the prostate. A doctor may advise this treatment for severe cases of chronic prostatitis or for men whose swollen prostate is blocking the flow of urine.
- Herbal medicines like diuretic and anti-inflammatory pill.
- Supportive therapies for chronic prostatitis, including stool softeners and prostate massage.
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