UTI in Men: Symptoms, Causes & Treatment Guide

What Is a Urinary Tract Infection?

A urinary tract infection (UTI) is a bacterial infection that affects any part of the urinary system, including the bladder (cystitis), urethra (urethritis), or kidneys (pyelonephritis). In men, UTIs often also involve the prostate gland (prostatitis). Most UTIs are caused by bacteria from the intestines, with E. coli responsible for 80-90% of cases.

The urinary tract consists of several connected structures: the kidneys filter blood to produce urine, which then travels through the ureters to the bladder where it's stored, and finally exits the body through the urethra. When bacteria enter this normally sterile system, they can multiply rapidly and cause infection. The body responds with inflammation, which produces the characteristic symptoms of a UTI.

Men have a significant anatomical advantage over women when it comes to UTI protection. The male urethra is approximately 20 centimeters long (compared to about 4 centimeters in women), making it much harder for bacteria to travel up to the bladder. This is why UTIs are approximately 30 times more common in women than men during younger adulthood. However, this protective advantage diminishes with age as the prostate gland enlarges and can obstruct normal urine flow.

Because UTIs are relatively uncommon in healthy young men, medical professionals typically consider any UTI in a male patient as potentially "complicated" – meaning it warrants investigation for underlying causes such as structural abnormalities, enlarged prostate, kidney stones, or other conditions that may predispose to infection. This approach ensures that treatable underlying conditions are identified and managed appropriately.

Two Types of Urinary Tract Infection

UTIs are classified based on their location within the urinary system, and this distinction has important implications for treatment and prognosis. Understanding the difference helps patients recognize when symptoms require urgent attention.

Lower UTI (cystitis) refers to infection of the bladder and urethra. This is the more common type and typically presents with symptoms localized to the lower urinary tract: frequent urination, burning sensation during urination, urgency, and discomfort in the lower abdomen. Importantly, lower UTIs usually do not cause fever. In men, the prostate gland often becomes involved in lower UTIs, which can cause additional symptoms like pelvic discomfort or a sensation of heaviness when sitting.

Upper UTI (pyelonephritis) occurs when infection ascends from the bladder to the kidneys, or less commonly through the bloodstream. This is a more serious condition that causes systemic symptoms including high fever, chills, severe back or flank pain, nausea, and vomiting. Patients with pyelonephritis typically feel significantly unwell. Upper UTIs require prompt antibiotic treatment and may necessitate hospitalization for intravenous antibiotics, particularly in elderly patients or those with other health conditions.

Bacteria That Cause UTIs

The vast majority of UTIs are caused by bacteria that normally live in the intestinal tract. Escherichia coli (E. coli) is responsible for approximately 80-90% of uncomplicated UTIs. This bacterium has specialized structures called fimbriae that allow it to attach to the cells lining the urinary tract, enabling it to colonize and cause infection despite the flushing action of urination.

Other bacteria that can cause UTIs include Klebsiella, Proteus (particularly associated with kidney stones), Enterococcus, Staphylococcus saprophyticus, and Pseudomonas. In hospital settings or in patients with urinary catheters, a wider variety of organisms may be involved, including bacteria that are more likely to be resistant to common antibiotics.

What Are the Symptoms of UTI in Men?

Common symptoms of UTI in men include frequent urination, burning or pain when urinating, urgency to urinate, lower abdominal pain, cloudy or foul-smelling urine, and sometimes blood in the urine. UTI with fever indicates a more serious infection involving the kidneys or prostate, requiring urgent medical attention. Elderly men may experience confusion as an unusual symptom of UTI.

The symptoms of a urinary tract infection result from the body's inflammatory response to bacterial invasion. When bacteria colonize the bladder wall, the immune system releases chemical signals that cause blood vessels to dilate and white blood cells to migrate to the area. This inflammatory response produces the irritation and sensitivity that characterizes UTI symptoms.

Recognizing UTI symptoms early is important because prompt treatment can prevent the infection from spreading to the kidneys or bloodstream. Men should be particularly attentive to these symptoms because, unlike in women where occasional UTIs are common and often self-limiting, UTIs in men frequently indicate an underlying condition that needs evaluation.

Symptoms of Lower UTI (Without Fever)

Lower urinary tract infections typically present with a constellation of symptoms related to bladder irritation. These symptoms can develop gradually or appear suddenly:

• Frequent urination (urinary frequency): Needing to urinate more often than usual, sometimes every hour or even more frequently. The bladder feels full even when it contains only small amounts of urine.
• Burning sensation during urination (dysuria): A stinging or burning feeling when urine passes through the urethra, often most intense at the end of urination.
• Urgency: A sudden, compelling need to urinate that can be difficult to delay, sometimes resulting in incontinence if a bathroom isn't immediately accessible.
• Lower abdominal discomfort: Pressure, cramping, or dull pain in the area above the pubic bone where the bladder is located.
• Cloudy or strong-smelling urine: Bacterial infection changes the appearance and odor of urine due to the presence of bacteria, white blood cells, and inflammatory products.
• Blood in urine (hematuria): Pink, red, or cola-colored urine can occur as inflammation damages small blood vessels in the bladder lining.
• Mild chills or feeling cold: Some patients experience mild constitutional symptoms even without fever.

In men, lower UTIs often involve the prostate gland to some degree. When this occurs, additional symptoms may include a sense of heaviness or discomfort in the perineum (the area between the scrotum and anus), pain that worsens when sitting, or discomfort during or after ejaculation.

Symptoms of Upper UTI (With Fever)

When infection spreads to the kidneys (pyelonephritis), the symptoms become more severe and systemic. This represents a more serious condition that requires prompt medical attention:

• High fever: Temperature above 38°C (100.4°F), often with significant fluctuations and accompanied by rigors (shaking chills).
• Severe back or flank pain: Pain in the sides or lower back at the level of the kidneys, often on one side but sometimes bilateral. The pain may be constant or come in waves.
• Nausea and vomiting: Kidney infection often triggers gastrointestinal symptoms that can lead to dehydration if severe.
• Feeling generally unwell: Fatigue, weakness, and a sense of being seriously ill that goes beyond typical bladder infection symptoms.
• Lower urinary symptoms: The bladder symptoms of a lower UTI may also be present, though sometimes they're overshadowed by the systemic illness.

UTI Symptoms in Elderly Men

Older adults may present with atypical symptoms that can make UTI diagnosis challenging. The classic symptoms of burning urination and frequency may be absent or mild, while other symptoms predominate. Elderly men with UTIs may experience increased confusion, agitation, or changes in behavior – sometimes these neurological symptoms are the only indication of infection.

This atypical presentation is particularly important in men with dementia, who may become more restless, confused, or exhibit behavioral changes when they have a UTI. Caregivers and family members should be aware that sudden changes in mental status in an elderly man warrant evaluation for possible urinary infection.

When Should You See a Doctor for UTI?

Men should seek medical care for any UTI symptoms, as urinary infections in men often indicate underlying conditions that need evaluation. Seek urgent care if you have fever with UTI symptoms, severe back or flank pain, inability to urinate, or signs of severe infection. Unlike women, men should not self-treat suspected UTIs without medical evaluation.

The approach to UTIs in men differs significantly from that in women. While healthy young women with classic cystitis symptoms can often be treated empirically based on symptoms alone, UTIs in men warrant medical evaluation to identify potential underlying causes and ensure appropriate treatment. This is particularly true for first-time UTIs in men, recurrent infections, or any UTI accompanied by fever or systemic symptoms.

Medical evaluation serves multiple purposes: confirming the diagnosis with urine testing, identifying the causative bacteria and their antibiotic sensitivities, assessing for complications, and investigating potential underlying causes such as enlarged prostate, kidney stones, or structural abnormalities. This comprehensive approach helps ensure effective treatment and prevents recurrence.

When to Contact Your Doctor

Schedule an appointment with your healthcare provider if you experience:

• Burning sensation or pain when urinating
• Increased urinary frequency or urgency
• Lower abdominal discomfort or pelvic pain
• Cloudy, bloody, or foul-smelling urine
• Any urinary symptoms that are new or unusual for you

Most healthcare clinics can accommodate same-day or next-day appointments for UTI symptoms. While waiting for your appointment, stay well hydrated by drinking plenty of water – this helps flush bacteria from the urinary tract and may provide some symptom relief. Over-the-counter pain relievers like acetaminophen or ibuprofen can help manage discomfort.

When to Seek Urgent or Emergency Care

Certain symptoms indicate a more serious infection or complication that requires immediate medical attention. Seek urgent or emergency care if you experience:

• Fever above 38°C (100.4°F) with urinary symptoms – this suggests the infection may have spread to the kidneys or prostate
• Severe pain in your back, side, or flank area
• Complete inability to urinate (urinary retention) – this is a medical emergency
• Visible blood clots in the urine or significant bleeding
• Nausea and vomiting preventing you from keeping fluids down
• Signs of sepsis: rapid heartbeat, rapid breathing, confusion, feeling faint, or clammy skin

If you have an existing health condition such as diabetes, kidney disease, or a weakened immune system, you should have a lower threshold for seeking medical care, as these conditions increase the risk of serious complications from UTIs.

How Is UTI in Men Diagnosed?

UTI diagnosis in men involves urinalysis to detect signs of infection and urine culture to identify the specific bacteria and guide antibiotic selection. A clean-catch midstream urine sample provides the most accurate results. Additional tests such as prostate examination, blood tests, or imaging may be performed to check for complications or underlying causes.

Accurate diagnosis of UTI is essential for effective treatment. While symptoms can strongly suggest a urinary infection, laboratory testing confirms the diagnosis and provides crucial information about which bacteria are causing the infection and which antibiotics will be effective against them. This approach helps ensure successful treatment while minimizing the development of antibiotic resistance.

The diagnostic process for UTI in men is typically more thorough than in women because of the need to identify underlying causes. Your healthcare provider will take a detailed medical history, perform a physical examination, and order appropriate laboratory tests. In some cases, imaging studies may be recommended.

Urine Testing

Urinalysis is usually the first test performed. This can provide rapid results and detect signs of infection including white blood cells (pyuria), red blood cells, bacteria, and nitrites (produced by some bacteria). A positive urinalysis supports the diagnosis of UTI but cannot identify the specific organism or its antibiotic susceptibility.

Urine culture is the gold standard for UTI diagnosis. A sample of urine is placed on culture media and incubated to allow bacteria to grow. After 24-48 hours, the laboratory can identify the specific bacteria present and perform antibiotic sensitivity testing to determine which antibiotics will effectively kill the organism. This information is particularly valuable if initial treatment doesn't work or for recurrent infections.

For accurate results, a midstream clean-catch urine sample is essential. This technique involves cleaning the urethral opening, starting to urinate into the toilet, then collecting the middle portion of the urine stream in a sterile container. This method minimizes contamination from bacteria that normally live on the skin.

Physical Examination

Your doctor will likely perform a physical examination, which may include:

• Abdominal examination: Checking for tenderness over the bladder (suprapubic area) or kidneys (costovertebral angle tenderness)
• Digital rectal examination (DRE): This allows assessment of the prostate gland for enlargement, tenderness, or abnormalities. A tender, swollen prostate suggests prostatitis.
• Genital examination: Checking for signs of other conditions that might cause similar symptoms

Additional Tests

Depending on your symptoms, medical history, and initial test results, additional investigations may be recommended:

• Blood tests: Complete blood count (CBC) and C-reactive protein (CRP) can indicate systemic infection. Kidney function tests may be ordered if upper UTI is suspected.
• Chlamydia and gonorrhea testing: In sexually active men, these sexually transmitted infections can cause urethritis with similar symptoms to UTI.
• Post-void residual measurement: Ultrasound to check if the bladder is emptying completely, as residual urine increases infection risk.
• Imaging (ultrasound or CT scan): May be performed if kidney infection is suspected, to look for kidney stones, or to evaluate for structural abnormalities.
• Cystoscopy: A procedure where a thin camera is passed through the urethra to examine the bladder and urethra directly. This may be recommended for recurrent infections or if abnormalities are suspected.

How Is UTI in Men Treated?

UTI in men is treated with antibiotics, typically for 7-14 days depending on the severity and whether the prostate is involved. Common antibiotics include trimethoprim-sulfamethoxazole, fluoroquinolones, and nitrofurantoin. The specific antibiotic is chosen based on urine culture results. It's essential to complete the full course of antibiotics even if symptoms improve to prevent recurrence and antibiotic resistance.

Antibiotic therapy is the cornerstone of UTI treatment. Because men's UTIs often involve the prostate gland to some degree, treatment courses are typically longer than those prescribed for women with uncomplicated bladder infections. The choice of antibiotic depends on several factors including the suspected or confirmed causative organism, local antibiotic resistance patterns, kidney function, allergies, and potential drug interactions.

Treatment should be initiated promptly after urine samples are collected for culture. While waiting for culture results (usually 24-48 hours), empiric antibiotic therapy is started based on the most likely causative organisms. Once culture results are available, the antibiotic can be adjusted if necessary to ensure optimal treatment.

Antibiotic Treatment

Several classes of antibiotics are commonly used to treat UTIs in men:

• Trimethoprim-sulfamethoxazole (TMP-SMX): A first-line option for uncomplicated UTI where local resistance rates are low (below 20%). Typically prescribed for 7-10 days.
• Fluoroquinolones (ciprofloxacin, levofloxacin): Effective against most UTI-causing bacteria and achieve good concentrations in prostate tissue. Often used when prostatitis is suspected. However, due to concerns about side effects, they're now reserved for situations where other options aren't suitable.
• Nitrofurantoin: Effective for lower UTI but does not achieve adequate levels in the prostate or kidneys, so it's not suitable for complicated infections.
• Beta-lactam antibiotics (amoxicillin-clavulanate, cephalosporins): May be used based on culture results, particularly for organisms resistant to first-line agents.

Treatment duration varies based on infection type and severity. Uncomplicated lower UTI typically requires 7 days of treatment, while prostatitis or upper UTI may require 14 days or longer. If acute bacterial prostatitis is diagnosed, antibiotic therapy usually continues for 2-4 weeks to ensure complete eradication of bacteria from the prostate tissue.

Hospital Treatment

Some UTIs require hospital admission and intravenous antibiotics:

• Severe pyelonephritis with high fever or systemic illness
• Inability to take oral medications due to nausea and vomiting
• Signs of sepsis or bacteremia
• Acute urinary retention requiring catheterization
• Complicated infections in immunocompromised patients

In the hospital, intravenous antibiotics are administered until fever resolves and the patient can tolerate oral medications. Treatment is then continued with oral antibiotics to complete the course.

Supportive Measures

In addition to antibiotics, several measures can help manage symptoms and support recovery:

• Hydration: Drinking plenty of fluids helps flush bacteria from the urinary tract and may speed recovery. Aim for at least 2-3 liters of water daily unless you have fluid restrictions.
• Pain relief: Over-the-counter pain relievers such as acetaminophen or ibuprofen can help manage discomfort. Some urinary analgesics (phenazopyridine) provide targeted relief of burning symptoms.
• Rest: Adequate rest supports the immune system's fight against infection, particularly for upper UTIs or prostatitis.
• Avoid irritants: Reducing caffeine and alcohol intake may help minimize bladder irritation during the acute phase.

What If You Get UTIs Repeatedly?

Recurrent UTIs in men (two or more infections in 6 months or three in a year) require thorough investigation for underlying causes such as enlarged prostate, urinary retention, kidney stones, or structural abnormalities. Management may include treating the underlying cause, prophylactic antibiotics, or lifestyle modifications. Men with recurrent UTIs should see a urologist for comprehensive evaluation.

While occasional UTIs can occur in otherwise healthy men, recurrent infections warrant careful evaluation. Unlike women, where recurrent UTIs are often related to anatomical factors and can be managed with preventive strategies alone, recurrent UTIs in men frequently have an identifiable underlying cause that, once treated, can prevent future infections.

The most common cause of recurrent UTIs in older men is benign prostatic hyperplasia (BPH) – an enlargement of the prostate gland that can obstruct urine flow and prevent complete bladder emptying. When urine remains in the bladder after voiding (residual urine), it provides an environment where bacteria can grow and establish infection.

Investigating Recurrent UTIs

Men with recurrent UTIs should undergo comprehensive evaluation, which may include:

• Detailed medical history: Pattern of infections, relationship to sexual activity, previous treatments, other medical conditions
• Post-void residual measurement: Ultrasound to determine if the bladder empties completely
• Prostate assessment: Size and characteristics evaluated by digital rectal examination and/or ultrasound
• Uroflowmetry: Measurement of urine flow rate to assess for obstruction
• Imaging: Ultrasound or CT scan to identify kidney stones, structural abnormalities, or other pathology
• Cystoscopy: Direct visualization of the bladder and urethra to identify abnormalities

Treatment Approaches for Recurrent UTIs

Management depends on the underlying cause identified:

• Treatment of BPH: Medications to reduce prostate size (alpha-blockers, 5-alpha reductase inhibitors) or surgical procedures to relieve obstruction
• Removal of stones: Kidney or bladder stones that harbor bacteria may need to be removed
• Catheter management: Optimizing catheter care or considering alternatives for men requiring long-term catheterization
• Prophylactic antibiotics: Low-dose antibiotics taken daily or after triggering events (such as sexual intercourse) may be prescribed for men with recurrent infections without correctable underlying causes

How Can You Prevent UTIs?

Prevent UTIs by staying well hydrated to flush bacteria from the urinary tract, urinating after sexual activity, completely emptying the bladder when urinating, practicing good hygiene, and managing underlying conditions like enlarged prostate. Men with recurrent UTIs may benefit from cranberry products, though evidence is limited, or prophylactic antibiotics prescribed by their doctor.

While not all UTIs are preventable, several lifestyle measures can significantly reduce the risk of developing urinary infections. These strategies work by limiting bacterial exposure to the urinary tract and maintaining optimal urinary function.

Hydration and Urination Habits

Adequate fluid intake is one of the most effective preventive measures. Drinking sufficient water (typically 1.5-2 liters daily for most adults) ensures regular urination, which flushes bacteria from the urinary tract before they can establish infection. Concentrated urine from dehydration may also be more irritating to the bladder and potentially more susceptible to infection.

Proper urination habits also play a role. Urinate when you feel the urge rather than holding it for extended periods. When urinating, take your time to ensure complete bladder emptying – rushing can leave residual urine. Some men with difficulty emptying may benefit from "double voiding" – urinating, waiting a moment, then trying again.

Sexual Activity

Urinating shortly after sexual intercourse helps flush any bacteria that may have been introduced near the urethral opening. This simple habit can significantly reduce UTI risk, particularly for men with recurrent infections related to sexual activity.

Hygiene Practices

Good genital hygiene helps minimize bacterial colonization near the urethral opening. For uncircumcised men, gently cleaning under the foreskin during regular bathing is important. Avoid harsh soaps or irritating products in the genital area. Wearing breathable cotton underwear and avoiding tight-fitting clothing can help maintain a healthy environment.

Managing Underlying Conditions

If you have an underlying condition that increases UTI risk, working with your healthcare provider to manage it effectively is crucial:

• Enlarged prostate: Medications or procedures to improve urinary flow
• Diabetes: Good blood sugar control to maintain immune function
• Constipation: Regular bowel movements reduce bacterial colonization near the urinary tract

Supplements and Alternative Measures

Several supplements have been studied for UTI prevention:

• Cranberry products: May help prevent bacterial adherence to the bladder wall. Evidence is mixed, with some studies showing modest benefit for women but limited data in men. If used, choose products with standardized proanthocyanidin content.
• Probiotics: May help maintain healthy bacterial balance, though evidence for UTI prevention is limited.
• Methenamine: A bacteriostatic agent that may be used for prevention in some cases, available by prescription.

What Are the Complications of UTI?

Untreated or severe UTIs can lead to serious complications including pyelonephritis (kidney infection), kidney damage, prostatic abscess, and sepsis (bloodstream infection). Older adults and those with weakened immune systems are at higher risk. Prompt treatment with appropriate antibiotics prevents most complications.

While most UTIs resolve completely with appropriate treatment, untreated or inadequately treated infections can progress to serious complications. Understanding these potential complications underscores the importance of seeking timely medical care and completing prescribed treatment.

Kidney Infection (Pyelonephritis)

When bacteria from a bladder infection ascend to the kidneys, pyelonephritis develops. This causes the systemic symptoms described earlier – high fever, flank pain, and feeling severely ill. Pyelonephritis requires prompt antibiotic treatment to prevent permanent kidney damage. Repeated kidney infections can lead to scarring and reduced kidney function over time.

Sepsis

In rare cases, bacteria from the urinary tract can enter the bloodstream, causing bacteremia and potentially sepsis. Sepsis is a life-threatening condition where the body's response to infection causes widespread inflammation, organ dysfunction, and potentially death. Signs of sepsis include high or low temperature, rapid heartbeat, rapid breathing, confusion, and feeling extremely unwell. This is a medical emergency requiring immediate hospital treatment.

Prostatic Abscess

Severe prostate infection can occasionally lead to abscess formation – a collection of pus within the prostate gland. This typically causes persistent high fever despite antibiotic treatment, severe pelvic pain, and difficulty urinating. Prostatic abscess may require drainage in addition to antibiotic therapy.

Chronic Prostatitis

Some men develop chronic prostatitis following acute infection. This causes persistent pelvic discomfort, urinary symptoms, and sometimes pain with ejaculation. Chronic prostatitis can be challenging to treat and may require prolonged antibiotic courses or other therapies.