Blood in semen (haematospermia): causes, when to see a GP and treatment

The NHS says most of the time it is not obvious what causes blood in semen and it goes away on its own, but it is important to get it checked to make sure it is nothing serious. It lists the common causes as an infection, such as a urinary tract infection (UTI) or sexually transmitted infection (STI), a recent procedure or test, such as transurethral resection of the prostate (TURP), a cystoscopy or a vasectomy, and a problem with the prostate, such as prostatitis or an enlarged prostate.

nidirect, which adapts NHS content, gives a longer list of common causes: urinary tract infection, infection in the testicles or epididymis, vesiculitis (inflammation of the seminal vesicles, the glands that produce most of the fluid in ejaculate), seminal vesicle cysts, prostatitis, recent urological surgery such as a prostate biopsy, cystoscopy or vasectomy, and STIs such as genital herpes, chlamydia, gonorrhoea or trichomoniasis. It says these problems generally are not serious and many get better on their own or after a course of antibiotics or anti-inflammatory painkillers.

Less often, nidirect says blood in the semen can be due to severe high blood pressure, a blood clotting disorder, cancer including prostate, testicular and bladder cancer, or seminal vesicle calculi (small stones in the seminal vesicles). It says these conditions are more serious and may require specialist treatment.

The NHS says to see a GP if you have blood in your semen. A GP can check for common causes and refer you to a specialist for more tests if needed.

nidirect explains that your GP will try to find out whether the cause is likely to be serious, and will consider how many times you have noticed blood, whether you have any other symptoms, your age and your medical history. The NHS lists other symptoms that may come with blood in semen depending on the cause: blood in your pee, pain when peeing or ejaculating, peeing more often than usual, pain in the area between the anus and scrotum, and pain in the abdomen, pelvis or scrotum.

nidirect says your GP may carry out simple tests including checking your blood pressure, examining your genitals and abdomen, a rectal examination, and urine and blood tests.

It says that a further assessment with a urologist may involve having a biopsy of your prostate gland or a scan, such as an ultrasound scan.

The NHS says blood in semen does not usually need to be treated and often goes away by itself in a few days or weeks. If a cause can be found, this may need to be treated. For example, a UTI or an STI may be treated with antibiotics.

nidirect says that in many cases, particularly if you have no other symptoms or the blood was an isolated incident, no treatment is necessary. Cysts may need to be drained with a needle, and if there is a serious cause such as a blood clotting disorder or cancer, you will be referred to a specialist for any necessary treatment.

The NHS lists a recent procedure or test, such as TURP, a cystoscopy or a vasectomy, among the common causes of blood in semen, and nidirect also lists a prostate biopsy. If blood appears shortly after one of these, it is a recognised effect, but you should still mention it to the team that did the procedure or to your GP, particularly if it persists or you have other symptoms such as fever or pain.

nidirect says that if you are younger than 40, have only noticed blood in your semen once or twice and tests do not show a serious underlying condition, you should not need a hospital referral. If you are over 40, have persistent symptoms or symptoms that often happen, or tests have suggested a potentially serious cause, your GP should refer you to a urologist.

The NHS says blood in semen is not usually caused by something serious and often goes away by itself. nidirect says it is usually only temporary, and the cause is rarely anything serious, and that it is understandable to find it alarming.

Because a small number of causes need treating, the advice from both is the same: have it checked once, report any further episodes or other symptoms, and do not ignore it if it persists.

Start with a GP, or a sexual health clinic if you think an STI is possible. A GP can check for common causes and refer to a urologist when needed, as the NHS and nidirect describe.

If you choose a private urology appointment for an earlier opinion, take along any results and ask for the findings to be shared with your GP so that PSA tests, scans and follow-up are kept together.