Help - bloody semen

[needsomehelp000]

Hi Drs-

20 days ago I had unprotected oral sex with a CSW.  This morning I masturbated, and blood was in my semen.  There is also a small, dark red / purple bump on the tip on my penis. It does not look like a blister, more like a mole actually.  A few other notes: I was diagnosed with prostatitis in January because of some discharge and painful urination.  I was tested for bacterial infections and was negative, so they said prostatitis and gave me a 2 week course of Cipro to knock that out.  I also have HSV-1 and get oral cold sores a few times per year.

Question: could this be herpes?  remnants of my prostatitis?  something more sinister?  should i see a urologist or an STD clinic?

thank you

[needsomehelp000]

Correct, no reason to believe she is. Also, 75%+ of our regular encounters are protected. For the past year, I've had pain in my prostate when I ejaculate some times, and my GP said the prostatitis could be related to that or a long past bacterial infection. I'm under 40 so he didn't do a PSA test. Thanks for the prompt and thoughtful replies, great service.

[H. Hunter Handsfield, M.D.]

OK -- interesting.  Having such an overt urethral discharge is more typical of STD than prostatitis.  However, the urine STD tests are highly reliable.  And presumably you have no reason to suppose your regular partner is having sex with other people.

[needsomehelp000]

most recent before the prostatitis was a week prior with regular partner.  They tested me for bacterial STDs and all was negative via urine test.

[H. Hunter Handsfield, M.D.]

I don't know what to make of the penile bump, except that the color sounds like blood under the skin -- although I don't know how that would relate to hematospermia.  In any case, it's not a typical STD symptom.  Both problems should be evaluated professionally, as discussed above.

No recent sexual exposures at all before the prostatitis?  How long previously, including regular partner?  Were you tested for STDs?

[needsomehelp000]

My prostatitis was diagnosed like this:  No recent sexual exposures. Out of the blue, 2 days painful urination and at the end of day 2 large volume of cloudy discharge.  Went to GP, he did urinalysis which was clean.  He said since no exposures likely prostatitis, and prescribed the 2 weeks of Cipro.

What about the new bump?  It's very dark in color and and isn't very raised at all. Strange and appeared out of nowhere today.

[H. Hunter Handsfield, M.D.]

Greetings and welcome to the forum. Thanks for your question.

The medical term for bloody semen is hematospermia.  It is usually not a symptom of STD.  It can be triggered by minor trauma, e.g. from a vigorous bike ride, horseback riding, etc.  (I've had it myself a couple of times after long bike rides.)  And sometimes it occurs spontaneously, without obvious cause. Oral sex is low-risk for all STDs and zero risk for some. Gonorrhea is the only STD from oral sex that conceivably could cause hematospermia, but that is very unlikely without obvious discharge of pus from your penis and painful urination.

I suppose this could be related to your recent prostatitis, but probably not. Can you say more about that diagnosis? What were the symptoms? Did that also follow a new sexual exposure? Was STD testing done, and what were the results? How old are you? Some STDs are easily confused with prostatitis, and vice versa.

To be maximally safe, it would be a good idea to see the doctor, preferably a urologist and/or whoever cared for your prostatitis. Most likely nothing important will show up and you will be advised to just monitor the appearance of your semen over the next few ejaculations.  But better safe than sorry.

Perhaps I'll have more to say after you tell me more about your prostatitis.  In the meantime, don't be overly worried.  This usually is no big deal at all.

Best regards--  HHH, MD