{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:29:29Z","timestamp":1789086569576,"version":"build-2803163510"},"reference-count":35,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2023,7,11]],"date-time":"2023-07-11T00:00:00Z","timestamp":1689033600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Andrology"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To assess the impact of hematospermia in patients with acute epididymitis and its association with clinical, microbiological, and semen parameters.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p>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 (=\u00a0no other urogenital symptoms) was prospectively recruited, and differences between the groups were statistically evaluated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 324 patients with acute epididymitis, 50 patients (15%) had self\u2010reported hematospermia. This occurred with a median of 24\u00a0h before the onset of scrotal symptoms and was associated with significantly elevated prostate\u2010specific antigen levels compared to 274 patients without hematospermia (3.1\u00a0vs. 1.8\u00a0ng\/ml, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.01). The two most common etiological pathogens were <jats:italic>Escherichia coli<\/jats:italic> and <jats:italic>Chlamydia trachomatis<\/jats:italic>, and the bacterial spectrum was comparable in both epididymitis subgroups (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.859). 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\u2010glucosidase and zinc (always <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion and conclusion<\/jats:title><jats:p>In sexually active patients who develop acute epididymitis, self\u2010reported 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.<\/jats:p><\/jats:sec>","DOI":"10.1111\/andr.13489","type":"journal-article","created":{"date-parts":[[2023,7,4]],"date-time":"2023-07-04T05:27:34Z","timestamp":1688448454000},"page":"1001-1011","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Comprehensive evaluation of hematospermia in patients with acute epididymitis compared to patients with isolated hematospermia"],"prefix":"10.1111","volume":"12","author":[{"given":"Florian","family":"Dittmar","sequence":"first","affiliation":[{"name":"Department of Urology Pediatric Urology and Andrology Justus Liebig University Giessen Giessen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"Rosellen","sequence":"additional","affiliation":[{"name":"Department of Urology Pediatric Urology and Andrology Justus Liebig University Giessen Giessen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leo","family":"Reiser","sequence":"additional","affiliation":[{"name":"Department of Urology Pediatric Urology and Andrology Justus Liebig University Giessen Giessen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moritz","family":"Fritzenwanker","sequence":"additional","affiliation":[{"name":"Institute for Medical Microbiology Justus Liebig University Giessen Giessen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arne","family":"Hauptmann","sequence":"additional","affiliation":[{"name":"Department of Urology Pediatric Urology and Andrology Justus Liebig University Giessen Giessen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thorsten","family":"Diemer","sequence":"additional","affiliation":[{"name":"Department of Urology Pediatric Urology and Andrology Justus Liebig University Giessen Giessen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans\u2010Christian","family":"Schuppe","sequence":"additional","affiliation":[{"name":"Department of Urology Pediatric Urology and Andrology Justus Liebig University Giessen Giessen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Wagenlehner","sequence":"additional","affiliation":[{"name":"Department of Urology Pediatric Urology and Andrology Justus Liebig University Giessen Giessen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8072-1841","authenticated-orcid":false,"given":"Adrian","family":"Pilatz","sequence":"additional","affiliation":[{"name":"Department of Urology Pediatric Urology and Andrology Justus Liebig University Giessen Giessen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,7,11]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464\u2010410x.1991.tb15076.x"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/andr.13189"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.ju.0000144565.76243.b1"},{"issue":"1","key":"e_1_2_10_5_1","first-page":"1","article-title":"Clinical characteristics, etiology, management and outcome of hematospermia: a systematic review","volume":"9","author":"Madhushankha M","year":"2021","journal-title":"Am J Clin Exp Urol"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2021.06.007"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans\u20102020\u2010054473"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp10%D7;532413"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2013.08.050"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2014.12.005"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00345\u2010011\u20100726\u20108"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/andr.13260"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1210\/jcem.84.10.6079"},{"key":"e_1_2_10_14_1","unstructured":"WHO.WHO laboratory manual for the Examination and processing of human semen. 5th Edition. World Health Organization;2010."},{"key":"e_1_2_10_15_1","unstructured":"WHO.WHO laboratory manual for the Examination and processing of human semen. 6th Edition. World Health Organization;2021."},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/3-540-33713-X_73"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.2164\/jandrol.05064"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/and.13401"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa043802"},{"key":"e_1_2_10_20_1","unstructured":"CDC.Sexually transmitted diseases treatment guidelines. Centers for Disease Control and Prevention.2010."},{"key":"e_1_2_10_21_1","unstructured":"EAU.EAU Guidelines edition presented at the 28th EAU Annual Congress. 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