Dear Kate, It all depends on being able to differentiate between whether the blood is mixed in the urine or is being added from the outer side. You should try and retract the foreskin only if it is loose and examine it carefully, and also the underlying glans penis. If there are no visible marks or injuries, you should approach a doctor to get his urine tested. However, the complaint of itching goes more in favour of an external wound. Only after this will we be able to decide on the line of treatment. Yes, it can be a bladder infection (hemorrhagic cystitis), a fungal infection (though this is rare in males and more common to see in females) or even a frank urinary tract infection. If, however, there is no infection, we would need to conduct more tests to arrive at an alternative diagnosis.