Patient's question:
Duration of onset and illness: Presence of hematospermia, no other discomfort. Ultrasound showed: no abnormalities in the prostate and seminal vesicles. I consulted several specialists locally, some prescribed gatifloxacin, others levofloxacin, some said roxithromycin is more effective, and a few even said that hematospermia doesn't require treatment at all.Expert advice: Is hematospermia necessary to be treated? If antibiotics are used for treatment, which of the above medications is best (with fewer side effects and better efficacy), or are there other better medications with fewer side effects and better efficacy?
First follow-up question: (2007-10-13 10:33:12) Thank you for the answers from the experts. I would like to ask about antibiotics.
Doctor's answer:
Semen suddenly changes from its normal creamy white color to blood-red, brownish-red, or mixed with blood streaks, of course containing blood. So where does the blood come from? It must be due to a pathological change in some part of the spermatic pathway, such as bleeding, inflammation, or even a tumor. Do not take hematospermia lightly; it could also be a sign of a serious disease. It is best to consult a specialist doctor for a thorough examination. Clinically, hematospermia is not uncommon. After detailed clinical and laboratory tests, the majority can be controlled or cured with treatment, while only a very small number of tumor patients require further treatment.The composition of semen, apart from the small volume of sperm, primarily comes from the seminal vesicles, followed by the prostate. Anatomically, the ejaculatory duct connecting the seminal vesicles opens at the urethral crest of the posterior urethra, surrounded by 10–20 openings of prostatic ducts. In fact, the seminal vesicles, prostate, and posterior urethra are interconnected, making it easy for inflammation to spread from one to the others. Additionally, the wall of the seminal vesicle is very thin; once congested, the blood-filled wall is prone to bleeding. Therefore, the most common causes of hematospermia are first seminal vesiculitis, followed by prostatitis, posterior urethritis, or posterior urethral congestion. It can also be caused by inflammation spreading from nearby organs, leading to inflammation, swelling, congestion, and bleeding of the seminal vesicle wall. Generally, at least 70% of hematospermia cases under 30 are caused by inflammation. If hematospermia occurs only occasionally and no specific changes are found upon examination, it may be due to minor blood vessel rupture and bleeding in certain tissues during intercourse due to sudden congestion and mechanical impact. In such cases of transient hematospermia, there is no need to panic—cessation of sexual activity for one or two weeks is usually sufficient for full recovery. Hemorrhage caused by inflammation tends to fluctuate but does not last long. If hematospermia persists and worsens continuously, the possibility of a tumor cannot be ruled out. Some patients may also have widespread bleeding tendencies in other parts of the body, which could indicate systemic hemorrhagic disorders such as leukemia or thrombocytopenia, rather than the result of local pathology. Other causes include tuberculosis, seminal vesicle cysts, seminal vesicle tumors, prostate cancer, portal hypertension due to liver cirrhosis, trauma, urinary tract obstruction, and benign prostatic hyperplasia.