Blood in semen infection?

User

Posted 10 Mar 2024 at 15:05

Hi, was hoping to get some insights into my haematospermi I currently have. About 1 year ago after a trip to Greece I noticed my semen was almost brown, which cleared through pretty quickly. Since then I had several reoccurrences, but more red coloured sperm and spaced apart by a few weeks. I was a little concerned as you can imagine so booked in with GP, who performed a urine test there and send some away (both came back normal) On top of this I had a physical prostate exam and blood test. I have private medical insurance so was referred to a Urologist, who again performed a physical prostate exam and a PSA blood test. The Dr explained how common this is and most of the time is a begine condition that will clear up. He said that if my PSA and blood test comes back fine then I have nothing to worry about. My bloods came back all within range and the PSA I had were 1.08 and 1.18

I did feel reassured and thought nothing more of it, until I had several more episodes during the rest of last year. I did have around 2 months of normal ejaculate until Jan this year when I started ejaculating blood again, so decided to go for a second opinion (private), and have had an MRI on prostate ( no discernible tumour, focus blood degradation products in right seminal vesicle). Also had an ultrasound upper tracts which came back normal. As a second opinion I was reviewed at the MDT discussion and response was the MRI showed no concerning features that required any further follow up. However as I was still incredibly anxious he booked me in for another ultrasound but of my testies and also a flexible cystoscopy. The results from my flex were ‘normal anterior and posterior urethra with non-occlusive prostate and a normal bladder neck. The bladder was inspected 3 times and was macroscopically normal. Both ureteric ori􏰂ces were seen at the inter-ureteric bar’. The results from my ultrasound scan of testes was ‘commensurate with epididymitis’.

My Doctor did sign me off after prescribing another 28day course of Doxycycline 100 mg and put the haematospermia cause down to lifestyle (I do 4-5 HIT sessions a week as well as cycle). I did ask if the infection could be the root cause of this and was told it was not, which really confused me as one of the main symptoms of epididymitis is blood in semen, which is the main reason for the incredibly long post. What are your opinion on the infection being root cause of this as I am still encountering red/brown semen.

Also how long could I have had this infection (way back to last March, when this all started) and how long can it take to clear up?

Any thoughts opinions most welcome

Cheers

User

Posted 12 Mar 2024 at 12:16

I do know that blood in the urine is not necessarily uncommon for someone who does extensive cycling or running, however that is when they do the dipstick or look microscopically, not generally visible to the eye. I now know visibly what blood looks like in semen from ejaculation in the first weeks after prostate biopsy. I was repeatedly told about it before the biopsy to get myself I guess prepared but certainly disconcerting the first time observed. My first MpMRI was basically negative with scarring appearing it was said from past prostititis. In between my first and second MpMRI 18 months apart, with my PSA going up and down, but no higher than a 4 and back down to a 2.4 but going back and forth like a yo-yo (had been stable for years at 1.9) my urologist had me do the ExoDx urine marker test which the cutoff for likely cancer needing a biopsy was 15, and I came back 60, which resulted in the 2nd MpMRI and ultimately the biopsy.

You know your body and stay persistent. You seem like you have been a good advocate for yourself and going down each path eliminating possibilities. It seems like the cystoscopy would have cleared up a lot of things also. There are prostate cancers your PSA does not rise high and can remain relatively low. You could see about the ExoDx urine test and if you were under the 15 you could get some relieve there is nothing in the prostate you likely have to address immediately as that infers a slower growing low level Gleason.

User

Posted 12 Mar 2024 at 14:41

Hi thanks for getting back, I’m relatively reassured that I have nothing to be concerned about regarding cancer and prostate. Was after people’s experience/ opinion regarding the correlation between the testicular infection and blood being present in semen and blood being picked up via scans/mri in right seminal vesicle? Cheers

User

Posted 12 Mar 2024 at 19:47

This has come up a couple of times in a local support group where we have urology consultants to answer questions. Their response is that you need to be checked to rule out that there's anything nasty going on (which you have been), but usually the cause is never found. It sounds like the location of the bleeding has been identified in your case, right seminal vesicle. Bleeding which wasn't fully re-absorbed by the body shows up very brightly on MRI scans, because the iron left behind when the red blood cells break down goes rusty and is strongly magnetic (and is also what causes rust coloured semen).

I saw a statistic from one US hospital which said 14% of haematospermia cases referred to them turned out to be prostate cancer, but you've been checked for that. (I suspect the total incidence rate may be lower, as many cases will never be referred to hospital.) High blood pressure is another possible cause, but no cause found is the most common outcome.

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