LETTERS TO EDITOR 259 4. Hillman RS, Ault KA, Rinder HM, editors. in the urogenital region was found. The Hematology in clinical practice: A guide to prostate was normal in size and consistency, diagnosis and management. 4th ed. New York: and no abnormal masses were palpable on McGraw-Hill Professional; 2005. p. 137-50. digital examination. External genitalia, testes, DOI: 10.4103/0019-5359.53396 epididymis, cord and penile urethra were normal. Seminal vesicles were not palpable. RECURRENT HEMATOSPERMIA The urethral meatus was evaluated, and DUE TO ASPIRIN no evidence of trauma, condylomata and phimosis was found. Hematologic studies Sir, (PT, PTT, CBC and ESR), urinalysis, urine The presence of blood in the semen culture, semen analysis and semen culture is called hematospermia and represents were done, and none of these revealed any 1% of all andrologic and urologic abnormality. Results of PSA test, mycobacterial symptoms.[1] Hematospermia is an uncommon cultures, urethral cultures for gonorrhea clinical condition that usually follows a painless, and chlamydia, transrectal ultrasound of the benign and self-limited course; but it can be a prostate and abdominopelvic sonography source of considerable fear and anxiety that were normal. Empirical treatment with an is uncommonly associated with significant antibiotic (quinolone) and an anti-infl ammatory underlying pathology and is mostly considered medication (selective COX-2 inhibitor) was to be idiopathic in nature.[2] Hematospermia administered, to which there was no response. is classifi ed by its cause, which may be an The patient was evaluated for epididymitis, infl ammation or infection, an obstruction or cyst, prostitis, urethritis, HIV, condylomata, urinary a vascular abnormality, a systemic disease, a stones, liver cirrhosis, arterial hypertension, tumor or an idiopathic condition.[3] Management genitourinary TB and hematologic disease, and with appropriate clinical evaluation, watchful he was normal in all these assessments; so the waiting, and reassurance often suffi ces without specialists reassured him that this condition further diagnostic workup or treatment.[2] was benign and self limited. Finally, he reported A 32-year-old man referred to our hospital ASA consumption due to hemoconcentration in Gorgan, north of Iran; he presented with 2 years ago. ASA effect as a causation of recurrent painless hematospermia of 18 hematospermia was suspected. We carried months’ duration. He did not have any history out coagulation tests (PT, PTT, BT, and CT), of urinary tract infections; sexually transmitted which, again, were normal except for BT, diseases; prolonged and intense masturbation which was slightly prolonged. So ASA was or sexual intercourse; hypertension; renal, liver discontinued and hematospermia stopped and or bleeding disorders; abdominal trauma or was not found to appear during the follow-ups surgery. He did not report erectile dysfunction in the following 6 months. For confi rmation of (International Index of Erectile Function the mentioned diagnosis, ASA was restarted score, 25). The fi ndings of general physical and hematospermia reappeared. We can examination of the patient were normal. No affirm this cause-and-effect relationship to evidence of trauma or self-instrumentation some extent because of the reappearance of Indian J Med Sci, Vol. 63, No. 6, June 2009 260 INDIAN JOURNAL OF MEDICAL SCIENCES hematospermia when ASA was restarted. The research participants are the two cornerstones etiology in relation to this fi nding may be that of ethical research. A previous study has noted hematospermia could have been caused by that only 30% of manuscripts published in 2 micro-trauma after ejaculatory contractions, Indian pediatric journals have mentioned ethics and aspirin may have been a contributing committee approval (ECA), and only 47% of factor by damaging the integrity of a congested prospective study reports have indicated that mucosa or interfering with platelet function, informed consent (IC) was obtained.[1] Because which could have produced hematospermia. authors prepare manuscripts on the basis of The importance of this case presentation is guidelines provided by journals, we examined that no similar reports about the side effects of if Indian medical journals provide explicit aspirin are found in the literature according to guidelines to their contributors in this regard. our search. We obtained a list of Indian journals from LAILY NAJAFI, AMIR HUSSEIN NOOHI1 Departments of Clinical Research and 1Pediatrics, Google (www.google.co.in/), PubMed (http:// Golestan University of Medical Sciences, Gorgan, Iran www.ncbi.nlm.nih.gov/pubmed/), MedIndia Correspondence: (www.medindia.net/doctors/journals/indian/ Dr. Amir hussein Noohi, Iran-Gorgan-Taleghany hospital Gorgan Iran indian_journals.asp?alpha=j) and the National Email: [email protected] Informatics Center (http://indmed.nic.in/). The journals belonging to streams of medicine REFERENCES other than allopathy (modern medicine), like those on Ayurveda, Siddha or Unani medicine, 1. Polito M, Giannubilo W, d’Anzeo G, Muzzonigro G. and those whose ‘Instructions to authors/ Hematospermia: Diagnosis and treatment. Arch contributors’ could not be located were excluded Ital Urol Androl 2006;78:82-5. from analysis. Also, newsletters, periodicals 2. Torigian DA, Ramchandani P. Hematospermia: and journals that published only reviews were imaging fi ndings. Abdom Imaging 2007;32:29-49. 3. Labadie P, Hellstrom WJ. Hematospermia excluded. The ‘Instructions to authors’ were diagnosis, evaluation, and clinical relevance. read by all the three authors of this article Contem Uro Arch 1999;11:125-9. to determine whether ethical aspects were DOI: 10.4103/0019-5359.53397 mentioned and whether the guidelines explicitly required a mention of ECA and approval from the animal ethics committee, obtaining REPORTING ETHICAL IC and assent, and that research had to be PROCESSES: SURVEY OF carried out in accordance with the national ‘INSTRUCTIONS TO AUTHORS’ guidelines provided by the Indian Council of PROVIDED BY INDIAN Medical Research, 2006,[2] or Declaration of JOURNALS Helsinki.[3] From a list of 340 Indian medical periodicals (including journals, bulletins and Dear Sir, other scientifi c publications), 240 were excluded Ethical approval by an independent review from the analysis as their print or electronic board and written informed consent given by versions could not be located (166) or they Indian J Med Sci, Vol. 63, No. 6, June 2009.