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Sexual health update: prostatitis and haematospermia

Dr Neil Lazaro advises on diagnosis and management of these two conditions


Not caused by STIs. Prostatitis can be:

•Acute (bacterial infection secondary to UTI) or


– bacterial (complication of acute


– abacterial (unknown cause)

Acute prostatitis

Caused by UTI organisms (E. coli, Proteus, Klebsiella, etc)


An acute severe systemic illness – treat promptly

•Symptoms of UTI (dysuria, frequency,


•Symptoms of prostatitis (perineal/penile/rectal pain, acute


•Symptoms of bacteraemia (fever, rigors, arthralgia)


•Gentle PR reveals tender swollen warm prostate – do not do prostatic massage (can ppt bacteraemia)

•Fever, tachycardia


•Urine dipstick and MSU

•Blood cultures


•A serious infection – start empirical

treatment immediately

•Consider admission to urology if severe

•Ciprofloxacin 500mg po bd 28 days switched according to sensitivities (do not mix quinolones with NSAIDs because of risk of convulsions)

•If intolerant or allergic, then use trimethoprim 200mg po bd 28 days

•If not improving (beware urinary

retention due to prostatic oedema) admit under urologists

•At least four weeks' treatment needed to prevent chronic bacterial prostatitis

•If managed correctly, acute prostatitis is likely to be completely cured

•When better, refer for investigation of

urinary tract

•No need to trace sexual partners, as not sexually transmitted

Chronic prostatitis

Definition: signs present for more than six months (diagnosis often made before this)

•Chronic bacterial prostatitis – failure to resolve acute infection

•Chronic abacterial prostatitis – unknown cause (it could be persisting antigen inside prostate)


•Perineal pain

•Penile pain (especially at tip)

•Lower abdominal pain

•Testicular pain

•Ejaculatory discomfort/pain

•Rectal/lower back pain



Refer to urology


(Information based on reference above)

A fairly common symptom presenting to GPs


•Inflammation (prostate, seminal

vesticles, urethra, epididymis)

•Calculi of the above

•Systemic (clotting problems,


•Tumours (benign warts, BPH, prostate cancer, cancer of the bladder)

•Vascular (varicosities, a-v


•Introgenic/trauma (prostate biopsy,

vasectomy, local trauma)

•Unknown (fewer cases nowadays if fully investigated)


•Amount, colour, duration, frequency

•How was it observed? (Exclude sexual partner as source with condom test)

•Any other symptoms? (If weight loss,

consider STI or UTI)

•Drugs – aspirin, warfarin

•Is there a family history of prostate


•Is there a history of TB or



•BP, temperature

•Check for abdominal masses


•PR (re-examine urethral meatus after PR to see if there is a bloody discharge)


•Urine dipstick and MSU

•FBC, U&Es, LFTs, consider clotting screen

•STI screen

•Consider PSA if more than 40 years old, or if there is a family history of prostate cancer


•Most cases are benign and self-limiting so use conservative management

•Treat UTI or STI

•Refer to urology if more than 40 years old, or if persistent/recurrent symptoms

This article is based on Sexually Transmitted Infections in Primary Care by Dr Neil Lazaro, published by the RCGP sex, drugs and HIV task group and the British Association for Sexual Health and HIV. See


Neil Lazaro is a GP hospital practitioner in GU medicine in Lancaster, a member of the RCGP sex, drugs and HIV task group and he also sits on the BASHH clinical effectiveness group


Narouz and Wallace. Haematospermia: in the context of a genitourinary medicine setting

Int J STD & AIDS 2002; 13: 517-521

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