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

Question

Hello doctor,

I am a 33-year-old male. I have not had any previous health problems and am a non-smoker and non-drinker. Generally, I am feeling fine. For the past six months, I have been producing bloody semen with blood clots, and it has been happening more recently. I have also recently started feeling mild pain behind my right testicle.

Occasionally, my left testicle seems to change in size slightly and seems to almost disappear, and the right testicle becomes quite tender and firm. I had an ultrasound scan about six years ago and some cysts 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 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 in case 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?

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

Hematospermia (blood in semen) is fairly common. Generally it is not considered as a sinister sign. There is a whole list of possibilities for this theoretically, but once we ensure it is not due to a sinister cause and rule out treatable causes, like infections, we do not go 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 you need to ensure no testicular problem. With your symptoms with testes, you need another scan to be on the safe side, as the scope for examination to be conclusive. I suspect you have epididymal 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 is the rash or hematospermia related to an old history of chlamydia. Since you have not had any other urinary symptoms, I would not worry much about other tests related to the urinary tract.

However, I would also recommend sending semen for culture to see any infection in it. Lastly, about prostate cancer, it's virtually unheard of at your age. Finger examination of the prostate, PSA blood tests, and MRI scans of the prostate are the screening tests in general. But not something I would recommend if the scan comes back normal, and if you are still worried, an MRI then will be helpful as a last resort.

I hope this helps.