Acute seminal vesiculitis begins suddenly, with noticeable symptoms usually appearing within a short period (from several days to a week). In contrast, chronic seminal vesiculitis starts gradually, with symptoms slowly emerging and persisting over a more extended period, often for months or even years. The specific differences are as follows:

1. Hematospermia:

Hematospermia is a typical symptom of acute seminal vesiculitis. During ejaculation, the semen may contain pink, red, or blood-clot-colored blood, sometimes in large amounts, completely altering the appearance of the semen. The occurrence of hematospermia typically causes anxiety in patients but is also an important diagnostic criterion for seminal vesiculitis.

Patients with chronic seminal vesiculitis may also experience hematospermia. Still, compared to acute seminal vesiculitis, the symptoms of hematospermia may be milder, manifesting as intermittent episodes, with the blood in the semen appearing dark red or brownish.

2. Pain:

Patients with acute seminal vesiculitis often experience lower abdominal pain, which may radiate to the perineum and both sides of the groin. The pain is particularly pronounced during ejaculation, ranging from mild discomfort to severe cramping. This pain can lead to fear during sexual activity or ejaculation, thereby affecting the quality of sexual life.

The pain symptoms in chronic seminal vesiculitis are typically characterized by dull pain, mainly concentrated in the lower abdomen, perineum, and groin areas. The pain may intensify during ejaculation or after sexual activity but is generally less severe compared to acute seminal vesiculitis.

3. Frequent, Urgent, and Painful Urination

Seminal vesiculitis can irritate the bladder, neck, and posterior urethra, causing urinary symptoms such as frequent, urgent, and painful urination. Patients may frequently feel the urge to urinate but produce only small amounts each time, accompanied by a burning sensation or sharp pain in the urethra during urination.

Some patients with chronic seminal vesiculitis may also experience abnormal urination symptoms like frequent, urgent, and painful urination. Still, these symptoms are usually less pronounced than in acute seminal vesiculitis. Additionally, patients may experience symptoms like dribbling at the end of urination and urine splitting.

The treatment of seminal vesiculitis needs to be personalized according to the acute or chronic nature of the disease, its severity, and the individual condition of the patient:

Antibiotics are the primary drugs for treating acute seminal vesiculitis. Doctors choose sensitive antibiotics based on bacterial culture and sensitivity test results, commonly using cefuroxime and levofloxacin. The treatment course generally lasts 2-4 weeks to ensure complete pathogen eradication.

For patients with severe hematospermia, hemostatic drugs such as vitamin K and carbazochrome can be used to reduce the blood content in the semen.

If patients have pain symptoms, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and diclofenac sodium can be used to alleviate the pain. If patients have fever symptoms, antipyretic analgesics such as acetaminophen can be used.

The treatment of chronic seminal vesiculitis often requires a combination of methods.

In addition to antibiotic treatment, physical therapy methods such as warm sitz baths and prostate massage can be used to promote blood circulation in the prostate and seminal vesicles and alleviate symptoms. Traditional Chinese Medicine (TCM) treatments, such as Diuretic and Anti-inflammatory Pill, can also clear heat, remove dampness, and activate blood circulation.

Due to the prolonged course of chronic seminal vesiculitis, patients are prone to anxiety, depression, and other psychological issues. Therefore, psychological therapy is also an essential part of treating chronic seminal vesiculitis. Doctors may use psychological counseling and cognitive-behavioral therapy to help patients relieve psychological pressure and build confidence in treatment.

In summary, the symptoms of seminal vesiculitis are diverse, and there are differences in symptoms and treatment between acute and chronic seminal vesiculitis. 

Once symptoms of seminal vesiculitis appear, patients should promptly visit a hospital for professional treatment to avoid delays in the condition, which could affect reproductive health and quality of life.

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