Semen is the fluid released during sexual activity. It is a mixture that includes fluid from the vas deferens (10% of the total volume), fluid from the seminal vesicles (60%), prostate gland fluid (30%), and a small amount from specialized mucous glands, particularly the bulbourethral glands.
Normal semen is ivory in color and has a strong, fishy smell when expelled, with a sticky consistency. Sperm cells themselves cannot be seen with the naked eye, so the color of the semen is determined by the fluid from the vas deferens, seminal vesicles, and prostate gland.
The presence of blood or a chocolate color in semen indicates damage to the aforementioned organs. Possible causes may include infections, injuries, or tuberculosis.
Tuberculosis is caused by a type of bacillus discovered by a scientist named Koch, which is why the tuberculosis bacterium is also referred to as Koch’s bacillus. You may have heard much about pulmonary tuberculosis and its infection risks, but not as much about genital tuberculosis or other forms of the disease.
The tuberculosis bacterium can reside and cause disease in most organs of the body with varying frequencies of occurrence. In Vietnam, pulmonary tuberculosis accounts for the majority of cases, followed by spinal tuberculosis, renal tuberculosis, and genital tuberculosis.
Infection caused by the tuberculosis bacterium can be localized to a specific part of the genital system or affect multiple areas, and it can even be associated with tuberculosis of the urinary system. Genital tuberculosis is mostly due to infection from a tuberculosis focus originating in the urinary system, which is why it is often referred to as urogenital tuberculosis.
Worldwide, urogenital tuberculosis accounts for about 14% of extrapulmonary tuberculosis cases. Initial symptoms are often subtle, sometimes only presenting as mild fever in the evening and fatigue. If tuberculosis affects any part of the body, the bacterium can penetrate the mucous membrane, exposing and eroding blood vessels, leading to bleeding.
Similar to the tuberculosis bacterium, common bacteria that cause infections in the genital system can also lead to bleeding through this mechanism. To definitively diagnose urogenital tuberculosis, urine and semen tests must be conducted to search for the tuberculosis bacterium.
Blood tests may also yield positive results for tuberculosis when PCR testing is positive for the bacteria. This is a relatively modern and highly valuable test. If the tuberculosis bacterium is not found in semen and urine through standard microscopy, PCR testing can also be performed.
In such cases, it is advisable to monitor the situation further before deciding to seek medical attention. If after several tests the semen remains chocolate-colored or contains blood, the risk of tuberculosis is quite evident.
Doctor Nguyễn Khanh
