Cookie policy notice

By continuing to use this site you agree to our cookies policy below:
Since 26 May 2011, the law now states that cookies on websites can ony be used with your specific consent. Cookies allow us to ensure that you enjoy the best browsing experience.

This site is intended for health professionals only

At the heart of general practice since 1960

Sexual health update: prostatitis and haematospermia

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

Prostatitis

Not caused by STIs. Prostatitis can be:

•Acute (bacterial infection secondary to UTI) or

•Chronic:

– bacterial (complication of acute

infection)

– abacterial (unknown cause)

Acute prostatitis

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

Symptoms

An acute severe systemic illness – treat promptly

•Symptoms of UTI (dysuria, frequency,

urgency)

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

retention)

•Symptoms of bacteraemia (fever, rigors, arthralgia)

Signs

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

•Fever, tachycardia

Diagnosis

•Urine dipstick and MSU

•Blood cultures

Management

•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)

Symptoms

•Perineal pain

•Penile pain (especially at tip)

•Lower abdominal pain

•Testicular pain

•Ejaculatory discomfort/pain

•Rectal/lower back pain

•Dysuria

Management

Refer to urology

Haematospermia

(Information based on reference above)

A fairly common symptom presenting to GPs

Causes

•Inflammation (prostate, seminal

vesticles, urethra, epididymis)

•Calculi of the above

•Systemic (clotting problems,

drugs)

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

•Vascular (varicosities, a-v

malformations)

•Introgenic/trauma (prostate biopsy,

vasectomy, local trauma)

•Unknown (fewer cases nowadays if fully investigated)

History

•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

cancer?

•Is there a history of TB or

schistosomiasis?

Examination

•BP, temperature

•Check for abdominal masses

•Genitals

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

Investigations

•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

Management

•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 www.rcgp.org.uk/PDF/clinspec_STI_in_

primary_care_NLazaro.pdf

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

Reference

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

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

Rate this article 

Click to rate

  • 1 star out of 5
  • 2 stars out of 5
  • 3 stars out of 5
  • 4 stars out of 5
  • 5 stars out of 5

0 out of 5 stars

Have your say