Common presentation which is usually benign and self-limiting, but may cause patients considerable anxiety.
In most cases, an exact cause is never found. It is important to exclude sinister causes like cancer to reassure the patient.
It can be seen after a long period of abstinence.
Causes include:
- Infective or inflammatory – prostatitis, urethritis, HSV, ureaplasma/STI
- Post surgical (usually prostate biopsy)
- BPH or prostatic calculi
- Bleeding diathesis
- Systemic disorders – uncontrolled hypertension, amyloidosis
- Epididymo-orchitis
- TB or schistosomiasis
- Ejaculatory duct anomalies (cysts, stones)
- Cancers – prostate cancer, urethral cancer, rarely testicular
- Coital trauma
History:
- Age
- Number of episodes / recurrence / precipitating factors
- Presence or absence of concurrent haematuria
- Risk factors for prostate and other malignancy
- Risk factors for STIs, rarer infections like TB/schistosomiasis
- Other associated symptoms
- Medical history and medications, previous surgeries
Examination:
- Blood pressure
- Abdominal, genital and rectal examination
- Palpation of vasa
- Testicular masses
- Urethral abnormalities
- Prostatitis or prostate cancer
Investigations:
- Urinalysis and culture
- Urine cytology if appropriate
- Bloods including PSA, coags as appropriate
- STI screening if appropriate
- Cystoscopy if concerns
- MRI prostate or TRUS if concerns
- Schistosomiasis, TB testing etc if appropriate
Most cases are idiopathic and benign and will resolve without intervention.
Age > 40 is probably the main indication for further work up.