Hematospermia due to schistosome infection in travelers.

Sir—Schwartz et al. [1] highlight hematospermia as a presenting symptom of schistosomiasis and comment that this presentation seems to be rare among travelers with schistosomiasis, although it is perhaps more common than is generally perceived. Indeed, several reports other than the 2 mentioned in their article have documented this presentation in returning travelers [2–4]. It is important to note that hematospermia is only one alteration in semen quality associated with male genital schistosomiasis. Other changes include yellow (rather than red or brownish) discoloration and reduction in viscosity to a “watery” consistency [2, 5, 6], and these symptoms may be more common than is hematospermia. Subjective change in semen quality was a relatively common presentation among a series of returned travelers with schistosomiasis in New Zealand, being present in 7 of 13 males [2, 5]. All 7 had swum in Lake Malawi in southern Africa during the preceding 12 months, were infected with Schistosoma haematobium, and responded to treatment with praziquantel. Three also described testicular ache or urethral tingling. Interestingly, all 7 presented to a sexual health clinic with changes in their ejaculate as their principal symptom. This is an unusual presenting symptom, even in sexual health clinics, and should prompt a high suspicion of schistosomiasis for anyone who has visited an area of endemicity. Furthermore, this symptom is likely to be reported more frequently if specifically sought in males with suspected schistosomiasis. David R. Murdoch Microbiology Unit, Canterbury Health Laboratories, and Department of Pathology, Christchurch School of Medicine and Health Sciences, Christchurch, New Zealand