Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany.
Institute for Medical Microbiology, Justus Liebig University Giessen, Giessen, Germany.
Andrology. 2024 Jul;12(5):1001-1011. doi: 10.1111/andr.13489. Epub 2023 Jul 11.
Among the most commonly known causes of hematospermia are infections in the genitourinary tract, but no study exists that has comprehensively investigated hematospermia in patients with acute epididymitis.
To assess the impact of hematospermia in patients with acute epididymitis and its association with clinical, microbiological, and semen parameters.
Since May 2007, a total of 324 sexually active patients with acute epididymitis were recruited in a prospective cohort study. Patients received a comprehensive medical and sexual history, and clinical, sonographic, laboratory, and microbiological diagnostics. Antibiotic therapy was given according to European Association of Urology guidelines. Semen analysis was offered 14 days after the first presentation and initiation of therapy. Since 2013, a separate control group of 56 patients presenting with isolated hematospermia (= no other urogenital symptoms) was prospectively recruited, and differences between the groups were statistically evaluated.
Of 324 patients with acute epididymitis, 50 patients (15%) had self-reported hematospermia. This occurred with a median of 24 h before the onset of scrotal symptoms and was associated with significantly elevated prostate-specific antigen levels compared to 274 patients without hematospermia (3.1 vs. 1.8 ng/ml, p < 0.01). The two most common etiological pathogens were Escherichia coli and Chlamydia trachomatis, and the bacterial spectrum was comparable in both epididymitis subgroups (p = 0.859). Semen analysis at 14 days still showed hematospermia in 24% of patients associated with massive leukocytospermia. Compared to the hematospermia control group, the two epididymitis subgroups showed significantly increased inflammation markers (pH, leukocytes, and elastase), reduced sperm concentration, and reduced levels of alpha-glucosidase and zinc (always p < 0.01).
In sexually active patients who develop acute epididymitis, self-reported hematospermia is evident in 15% of patients as early as one day before the onset of scrotal symptoms. Conversely, none of the 56 patients presenting with isolated hematospermia developed epididymitis within the next 4 weeks.
血精最常见的病因之一是泌尿生殖道感染，但目前尚无研究全面调查急性附睾炎患者的血精症。
评估血精对急性附睾炎患者的影响及其与临床、微生物学和精液参数的关系。
自 2007 年 5 月以来，我们在一项前瞻性队列研究中招募了 324 名患有急性附睾炎的活跃性患者。患者接受了全面的医学和性病史、临床、超声、实验室和微生物学诊断。根据欧洲泌尿外科学会指南给予抗生素治疗。首次就诊和开始治疗后 14 天提供精液分析。自 2013 年以来，前瞻性招募了 56 名单独出现血精（即无其他泌尿生殖系统症状）的患者作为单独对照组，并对两组之间的差异进行了统计学评估。
在 324 名急性附睾炎患者中，有 50 名（15%）患者自述有血精。这发生在阴囊症状出现前的中位数 24 小时，与 274 名无血精症患者相比，前列腺特异性抗原水平显著升高（3.1 与 1.8ng/ml，p<0.01）。最常见的两种病因性病原体是大肠埃希菌和沙眼衣原体，两种附睾炎亚组的细菌谱相似（p=0.859）。14 天时的精液分析仍显示 24%的患者有血精症，并伴有大量白细胞精子症。与血精症对照组相比，两个附睾炎亚组的炎症标志物（pH、白细胞和弹性蛋白酶）显著升高，精子浓度降低，α-葡萄糖苷酶和锌水平降低（均 p<0.01）。
在患有急性附睾炎的活跃性患者中，有 15%的患者在阴囊症状出现前一天就已经出现了自报的血精症。相反，在接下来的 4 周内，没有任何单独出现血精症的 56 名患者发生附睾炎。
