Premise
In the previous discussion, we analyzed the problem of blood in the sperm in terms of incidence and causal elements: in this concluding article the condition will be treated from the diagnostic and therapeutic point of view, after having classified the various types of hematospermia.
Classification
Based on the clinical characteristics of the blood in the sperm, it is advisable to carry out a precise classification: in this regard, we distinguish the purely bright red blood, from the darker blood (brown or black) inside the seminal fluid.
When hematospermia becomes a particularly recurrent problem, the blood emitted along with the sperm, during ejaculation, tends to become darker, varying shades from brown to black. In almost all cases, patients complaining of episodes of brown blood in the sperm have previously witnessed the release of bright red blood in semen. Brown or black blood is the consequence of blood residues accumulated previously in the prostate or in the seminal bladder: due to oxidative processes, the color of the blood varies from bright red to burgundy - brown.
Diagnosis
The spermiogram is certainly the most suitable diagnostic test for the recognition of any pathogens in the sperm. Spermioculture, on the other hand, completes the spermiogram and gives an idea of the type and quantity of microorganisms present in the seminal fluid.
When the patient complains of episodes of blood in the sperm after the age of 50, a thorough prostate test is advisable: abnormal swelling and possible abscesses could be responsible for the bleeding under examination. When the ano-rectal medical palpation is not sufficient, the patient will have to undergo a trans-rectal ultrasound, surely more precise than the manual control: the latter shows other hypothetical pathologies, such as stones, prostate cysts, ejaculatory ducts or prostatic calcifications.
The PSA (Prostate Specific Antigen) test is a diagnostic screening test useful to exclude the possible possibility of prostate cancer.
Periodic monitoring of arterial blood pressure is advisable, especially in those patients with age: we have seen, in fact, that hypertension could represent a risk factor for hematospermia.
Again, in order to ascertain whether bleeding in the sperm derives from a prostatic or urethral morbid condition, cystoscopy and urethroscopy are recommended, respectively.
In case of suspected sexually transmitted infection, the relative diagnostic tests are appropriate.
Blood in sperm: therapies
When a particular cause is not identified, the treatment is empirical, based therefore on observation. Even in similar situations, some therapists still recommend the administration of tetracycline for a period varying from 5 to 7 days, a treatment possibly associated with a prostate massage.
When prostate biopsy ascertains the detection of pathogenic microorganisms, the patient is usually treated with antibiotics, possibly associated with phytotherapeutic drugs with an anti-inflammatory action. Administration of NSAIDs for prolonged periods is not recommended, as it could worsen haematospermia.
Some patients complain of blood in the sperm due to a narrowing (stenosis) of the urethra: in similar situations, some urethral dilators may be useful, while in cases of greater severity it is essential to have surgery.
However, these are sporadic cases, in which the blood in the sperm is certainly not the main problem, but only a secondary symptom, a consequence of more severe genital conditions. When cardinal disease is treated, hematospermia will no longer be a concern.
