How common are urinary tract infections (UTIs) in men?

Urinary tract infections (UTIs) are much less common in men than in women because most infections are caused by bacteria that colonise in the lower bowel, contaminate surrounding skin (perineum) then enter the urinary bladder (and can then go to the kidneys or the testicles) through the urethra. The urethra is much shorter in women than in men.

Here, one of our expert urologists from Oxford, Mr Simon Brewster explains the symptoms of a UTI in men, how they are examined and what the treatment options are.
 


How serious can a UTI be?

In terms of seriousness for both men and women, there is a spectrum with the most serious infections involving the kidney in the presence of obstruction or the development of abscesses within the kidneys or the prostate gland. Infections can also be more dangerous if the bacteria are resistant to commonly-used antibiotics.
 

What are the symptoms of UTIs in men?

Symptoms of infection involving just the bladder (cystitis), include burning pain when passing urine, frequency, urgency and blood in the urine (haematuria).

If the prostate gland is infected (acute prostatitis) there can be fever (temperature above 37.8 degrees Centigrade), shaking and more continuous deep pelvic pain.

When the testicle is involved, pain and swelling in the scrotum can develop.

When the kidneys are involved, pain develops in the loin/flank and often there is fever and shaking.
 

When is it better to see a GP or a specialist?

In the first instance, a visit to the GP is required. A midstream sample of urine should be stick-tested and if positive for infection this should be sent to a microbiology laboratory for culture and antibiotic sensitivities. An examination is performed as described below.

A single UTI in an adult male warrants a kidney and post-voiding bladder ultrasound scan to check for obstruction of the kidneys or bladder, or the presence of stones which can harbour bacteria.

If the ultrasound is abnormal or the UTI becomes recurrent then a specialist opinion is appropriate. If the infection is severe an emergency admission to hospital may be necessary, under the care of a urologist, or acute general medicine.
 

 How are men examined and diagnosed?

The bladder can be examined in the lower abdomen along with the external genitalia. A rectal examination to assess the prostate gland for tenderness is necessary, since prostatitis requires a longer course of antibiotics.

Urine is assessed by a dip-stick which can detect blood, pus cells, protein, bacterial nitrite production and glucose. Occasionally a UTI can present as a symptom of diabetes.
 

How are they treated?

A five-day course of oral antibiotics can be prescribed if necessary. If the infection is serious, intravenous antibiotics may be required usually in hospital and then continued for two to four weeks on occasions.

A urologist may be able to help by draining an abscess in the prostate or kidney, relieving bladder outflow obstruction by treating an enlarged prostate or removing a stone that is causing infection or obstruction.

You can book an appointment with Mr Brewster via his Top Doctor's profile here for his expert opinion if you are worried that you're experiencing a UTI.