An Overview of UTI in Men

Males can get urinary tract infections (UTIs). Because UTIs are more common among females, males often don't realize that they can also develop these infections. UTIs in males cause pain with urination, as well as other symptoms. These infections can often be diagnosed with a urinalysis (U/A), also called a urine test.

Some medical conditions, such as sexually transmitted infections (STIs) and prostate disease increase the risk of UTIs in males. Treatment for a UTI typically includes antibiotics and evaluation and management of the risk factors.

Symptoms

UTIs may cause a variety of symptoms in males. Sometimes these infections do not cause any symptoms in the early stages but cause noticeable effects as they worsen.

Symptoms of UTIs in males can include any of the following:

• Dysuria (pain or burning when urinating)
• A frequent feeling of constant pressure near the bladder (the center of the lower abdomen)
• Urinary retention (incomplete emptying of the bladder)
• Urinary urgency (feeling of an immediate need to relieve yourself)
• Increased urinary frequency, typically with just small amounts of urine
• Nocturia (waking up to urinate at night)
• Cloudy urine
• Milky discharge from the penis
• Foul-smelling urine
• Pain near the bladder
• Hematuria (blood in the urine)
• Incontinence (loss of bladder control)
• Flank pain (pain affecting the kidneys, on the lower back sides of the body)
• Fevers and/or chills
• Malaise (general feeling of being unwell)
• Nausea and/or vomiting

You can develop any of these symptoms. And for some males, the symptoms of a UTI can come and go for weeks before they suddenly worsen.

Complications

Without treatment, UTIs can cause major health problems. If you have a weak immune system, complications are more likely to occur.

Severe effects of a UTI that can develop in males include:

• Pyelonephritis: An infection involving the kidneys
• Sepsis: A dangerous, systemic, whole-body infection

Causes

UTIs can affect men of any age and for any number of reasons, and they are more common in older males. These infections are usually caused by bacteria, but they can be caused by viruses too.

There are several risk factors associated with UTIs, including:

• STIs
• Urethral stricture (blockage of the urethra)
• Previous UTIs
• Diabetes (too much sugar in the blood)
• Immune system problems
• Using a urinary catheter for a prolonged time
• Prostate enlargement
• Congenital malformation of the urinary tract
• Cancer of the urinary tract

In some cases, urethritis can happen for no known reason, a condition referred to as nonspecific urethritis (NSU).

These infections can affect any part of the urinary tract system, including the kidneys, the ureter (which connects the kidneys to the bladder), the bladder, and the urethra (tube through which urine leaves the body through the penis).

Young males who develop UTIs may have a congenital malformation of part of the urinary system. Males ages 20–35 are generally at low risk of developing UTIs unless it is caused by an STI. Having multiple sex partners and having sex without using a condom increases the risk of getting an STI.

Diagnosis

If you have symptoms of a UTI, your healthcare provider will likely take a detailed medical history and perform a physical examination.

In addition to your history and physical examination, you may need some tests to aid in your diagnosis. A urinalysis can often detect bacteria and other signs of infection. Other diagnostic tests are often needed to help identify whether there are anatomical issues that could be causing the infection.

Urine Test

A urine test may show an elevation of white blood cells, which is a sign of infection. Sometimes the type of bacteria causing the infection can be identified in a urine culture. A urine culture uses a sample of urine to evaluate bacterial growth over the course of several days in a lab.

Red blood cells in the urine are a sign of a severe infection or more significant urinary tract disease, requiring follow-up with a urologist.

There are a few other medical problems that can cause some symptoms similar to those of a UTI. For example, diabetes can cause urinary frequency and urgency, and a urinalysis can differentiate between diabetes (which causes high levels of glucose in the urine) and a UTI.

Imaging Tests

You may also need to have imaging tests, such as a computed tomography (CT) scan or ultrasound of the pelvis. These tests can detect problems such as growths, cancer, or malformations that may predispose you to a UTI.

Diagnostic Procedures

Depending on your condition, you may need certain diagnostic procedures that can give your healthcare provider more detailed information about your urinary tract anatomy. These tests are invasive and can be uncomfortable. If there is a concern that you could experience pain, you might need to have an anesthetic during the procedure.

A digital rectal examination is a test in which your healthcare provider examines the size and shape of your prostate by placing a gloved finger in your rectum. This test, along with results of imaging tests, can help identify prostate enlargement or serious problems, such as prostate cancer.

A cystoscopy is a test in which an instrument (can be flexible or rigid) with a camera is inserted into the urethra to observe the urethra and bladder from the inside. This test can detect anatomical defects such as strictures, and it may also help in diagnosing cancer.

Treatment

Usually, antibiotic medications are necessary for the treatment of a UTI. These are prescription medications that destroy bacteria. For the treatment of uncomplicated UTIs, oral (by mouth) antibiotics are usually adequate. However, for major complications such as sepsis or pyelonephritis, intravenous (IV) antibiotics may be typically necessary.

Your healthcare provider may initially select an antibiotic that is usually effective for treating UTIs in males, such as Macrobid (nitrofurantoin), Monurol (fosfomycin), Bactrim and others (trimethoprim-sulfamethoxazole), Cipro (ciprofloxacin), or Levaquin (levofloxacin).

Often, people feel better within a few days after starting an antibiotic for the treatment of a UTI. However, if you stop taking your antibiotics when you start feeling better rather than taking the full prescription, you are likely to have a partially treated infection, with a resurgence of symptoms a few days after you stop taking your antibiotics.

You should try to stay hydrated when recovering from a UTI. Passing an adequate flow of urine helps flush out the infectious organism. Ideally, water is the best fluid for staying hydrated, because sugary or caffeinated beverages can dehydrate you.

Managing Risk Factors

Reducing your risk of UTIs may require treatment of major medical issues. For example, if you have a prostate or bladder cancer, you may need surgery. If you have a congenital malformation, you may also benefit from a corrective procedure.

UTIs in males are not common, but any male can develop one. It is important that you seek medical attention if you develop symptoms of a UTI because these infections do not improve on their own.

Also, if you are prone to recurrent UTIs, it is vital that you discuss this with your healthcare provider so you can have treatment to reduce your risk.