28 April 2015

Answer: What's your diagnosis? - Case 8

In our latest case, a very distressed Mr E and his wife presented to their GP after noticing blood in his semen. The most likely cause of his problem is a sexually transmitted disease, but other more sinister causes should be excluded.


In our latest case Mr E noticed blood in his semen after sexual intercourse. Read the full case study here.

Finding blood in one’s semen is a very distressing experience for any man. Fortunately, in most cases, it does not indicate a major health problem, but it always needs to be checked out, especially after age 40, with repeated episodes, and when it is associated with other symptoms like difficulty urinating or a discharge from the penis.

The most common cause of blood in semen is infection somewhere in the urinary or reproductive tract. These include the prostatitis and urethritis (infection in the tube that carries semen and urine towards the penis).

Procedures like prostate biopsies or trauma to the penis or any part of the reproductive system can also cause blood in the semen.

A very common cause (some sources estimate about four out of every 10 cases) is sexually transmitted diseases (STD), i.e. gonorrhoea, Chlamydia and other bacterial infections.  This is also the most likely cause of Mr E’s episode of blood in his semen.  

Although we can’t say for sure that the cause was in fact an STD, in light of his history of having no erectile difficulties or problems with urinating, concluding that a major prostate problem (like cancer) is the likely cause is not ideal.

After a urine test, the GP concluded that Mr E’s problem was probably an infection.  The enlarged glands in his groin area support this diagnosis.

Examination of the prostate when presenting with any urogenital complaint is very important. Although it is very unlikely that Mr E’s problem has a sinister cause, the GP still needs to exclude all possible causes.

To conclude, the most likely diagnosis of Mr E’s problem with blood in his semen is a sexually transmitted disease. 

NOTE: Health24's on-site GP Dr Owen Wiese reveals new cases on Thursdays. The answer is posted with the story on Mondays, or you can get it on the Daily Tip – sign up here.

Previously on What's Your Diagnosis?

What's your diagnosis? – Case 1: vomiting and weight loss

What's your diagnosis? – Case 2: eye pain

What's your diagnosis -  Case 3: strange behaviour and a bullet in the back

What's your diagnosis - Case 4: seeing odd things

What's your diagnosis - Case 5: mysterious lungs

What's your diagnosis - Case 6: runner with seizures

What's your diagnosis - Case 7: swollen knee

Image: man holding his groin from Shutterstock

Dr. Owen J. Wiese is Health24's resident doctor. After graduating from Stellenbosch University with additional qualifications in biochemistry and physiology he developed a keen interest in providing medical information through the media.


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