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Q. I get bloody semen with clots and pain in my right testicle. What is my problem?

Answered by
Dr. Gokul Vignesh Kandaswamy
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Jun 02, 2020 and last reviewed on: Jun 20, 2020

Hello doctor,

I am a 33-year-old male. I have not had any previous health problems, non-smoker, and non-drinker. Generally, I am feeling fine. For the past six months, I have produced bloody semen with blood clots and producing more recently. I have also recently started feeling mild pain behind my right testicle. Occasionally, my left testicles seem to change in size slightly and seem to almost disappear and the right testicle becomes quite tender and firm.

I had an ultrasound scan about six years ago and there was found some cyst but little concern. About a week ago, I sensed a small lump rising above my right testicle to my lower abdomen, it was uncomfortable but I slept and the discomfort eventually went away. I see little blood-colored spots appearing on my arms and torso perhaps resembling perhaps petechiae and have an area of this rash on my torso that I am not sure may be related to my concern?

I have been taking Azithromycin since yesterday incase it may be a virus or something bacterial but it does not seem to be helping the problem. I had a blood test in January 2020, but have not been able to make a follow-up blood test yet. Not sure why it might be necessary. What does the problem sound like to you?

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Hello,

Welcome to icliniq.com.

Hematospermia (blood in semen), is fairly common. Generally it is not considered as a sinister sign. There are whole list of possibilities for this theoretically, but once we ensure it is not due to sinister cause and rule out treatable causes say like infections we do not beyond that as it will not affect the management.

Sinister causes mainly prostate and testicular cancers. At your age prostate cancer is extremely unlikely but need to ensure no testicular problem. With your symptoms with testes, you need another scan to be on safe side as the scope for examination to be conclusive. I suspect you have epidydimal cysts which are very common and can cause pain, etc. So if the scan does not show anything other than this, I would not worry about it at all.

I think the rash is completely unrelated to this or any of your urological problems. Nor the rash or hematospermia is related to old history of chlamydia. Since you have not had any other urinary symptom, I would not worry much about other tests related to urinary tract. However, I would also recommend sending semen for culture to see any infection in it.

Lastly about prostate cancer virtually unheard in your age. Finger examination of prostate, PSA blood test and MRI scans of prostate are the screening tests in general. But not something I would recommend if testes scan comes back normal and if you are still worried an MRI then will be helpful as last resort.


The Probable causes:

Idiopathic. Testicular pathology.

Investigations to be done:

Ultrasound scan of testes. Ideally an examination of genitals including prostate by a clinician. Semen culture.

Differential diagnosis:

Idiopathic.

Probable diagnosis:

Hematospermia.

Regarding follow up:

With reports.


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