Haematospermia

Fasting laboratory tests

• Blood FBC
• Serum electrolytes (basic biochemistry)if needednon-French guidelineThe EAU 2023 algorithm cites a “serum biochemistry panel” in the initial tests, without detailing its content ^[3]; a 2017 review mentions routine clinical chemistry ^[1]; the EAU 2026 text cites FBC, liver function tests and haemostasis, without electrolytes ^[2]. To be requested if a basic biochemistry panel is wanted in addition to FBC and haemostasis.
• PT, aPTT
• ASTif needednon-French guidelineThe EAU 2026 cites liver function tests with FBC and haemostasis to detect systemic disease (chronic liver disease, haemostasis disorders); the EAU 2023 algorithm speaks of a “serum biochemistry panel” without detailing it ^[2,3].
• ALT (liver function tests, looking for a systemic disease)if needednon-French guidelineThe EAU 2026 cites liver function tests with FBC and haemostasis to detect systemic disease (chronic liver disease, haemostasis disorders); the EAU 2023 algorithm speaks of a “serum biochemistry panel” without detailing it ^[2,3].
• Total PSA (man over 40, after information)if needednon-French guidelineThe EAU recommends screening for prostate cancer (PSA and digital rectal examination) in men aged 40 or over with persistent haemospermia (weak recommendation) ^[3]; in 2026 PSA is to be measured in men over 40 who have been informed about this test ^[2]. A 2017 review also recommends PSA after age 40 ^[1]. See the page “PSA: request for prostate cancer screening and raised PSA”.
• Semen analysisif needednon-French guidelinePersistent haemospermia or doubt about the nature of the blood: the EAU 2023 algorithm includes semen analysis in the initial tests ^[3]; a 2017 review advises examining the ejaculate under the microscope whenever possible, to distinguish true haemospermia from discolouration due to something else ^[1]. The EAU 2026 text requests it only if tuberculosis or schistosomiasis is suspected (return from an endemic area) ^[2].

On urine tests

• Urine microscopy and culture

STI tests

• HIV serology (if never screened or exposure)if neededThe EAU includes STI screening in the initial tests for haemospermia, without listing the serologies ^[2,3]. The French College of General Medicine proposes STI screening for an asymptomatic patient if never done, after a change of partner, in case of doubt about the partner or after unprotected sex with a casual partner; HIV serology is reliable 6 weeks after the last risk exposure ^[4].
• Syphilis serology (if never screened or exposure)if neededThe EAU includes STI screening in the initial tests for haemospermia, without listing the serologies ^[2,3]. It is in the French College of General Medicine's standard STI screening prescription, with the same indications as HIV serology ^[4].
• Hepatitis C serology (if exposure)if neededThe EAU includes STI screening in the initial tests for haemospermia, without listing the serologies ^[2,3]. The French College of General Medicine adds it as an option to the standard STI screening prescription; it is reliable 3 months after the last risk exposure ^[4].
• Hepatitis B serology (HBsAg, anti-HBs, anti-HBc) (if never screened or exposure)if neededThe EAU includes STI screening in the initial tests for haemospermia, without listing the serologies ^[2,3]. The French College of General Medicine places it in the standard STI screening prescription (HBsAg, anti-HBs, anti-HBc); it is reliable 3 months after the last risk exposure ^[4].

On first-void urine or self-collected sample

• Chlamydia trachomatis and Neisseria gonorrhoeae NAAT (PCR) on first-void urine (if exposure)if neededFor haemospermia, the EAU 2026 asks for full STI screening on first-void urine, serum and genitourinary samples, with testing for Chlamydia, Ureaplasma and herpes ^[2]. The French College of General Medicine proposes, as screening in an asymptomatic patient, Chlamydia and gonorrhoea PCR on first-void urine, with “asymptomatic” stated on the prescription ^[4].
• Chlamydia and gonococcus NAAT (PCR) on additional samples (throat, anus) depending on sexual practices and exposureif neededSeveral sites can be sampled according to the practices declared and exposure: urine (first-void), throat (pharyngeal swab), anus (self-collected anal swab) ^[4]. The fee schedule covers testing at 2 or 3 sites (procedures 5302 and 5303) on explicit prescription, in case of anal or pharyngeal sex ^[5].