UTI in men: Causes, symptoms and treatment

Approximately‍‌‍‍‌‍‌‍‍‌ one out of five men will be affected by urinary tract infections (UTIs) in their lifetime. Although UTIs are quite rare in young men, the frequency of such infections increases gradually with age. In men below 55 years of age, the incidence of urinary tract infections is less than three cases per 1,000 each year, whereas the number of cases rises to almost eight per 1,000 in those aged 85 and above. Male urinary tract infections represent a serious health problem, as they have the potential to cause infections in the blood (bacteraemia) and are frequently recurrent. Additionally, they are among the top causes of the prescription of antibiotics in primary ‍‌‍‍‌‍‌‍‍‌care.

Symptoms and causes of a Urinary Tract Infection

According to Harvard Health Publishing, in some cases, adults may also experience bedwetting if they were previously dry at night.

UTI symptoms can vary but commonly include:

1. Frequent urination
2. A strong or urgent need to urinate
3. Pain or burning during urination
4. Waking at night to urinate
5. Pain or pressure in the lower abdomen
6. Cloudy or foul-smelling urine
7. Fever, with or without chills
8. Nausea or vomiting
9. Pain in the side or upper back

Causes

UTIs are mostly frequent in women; however, they are not impossible in men. The risk of a male UTI rises with age. In males that are more than 50 years old, the situation in which the prostate gland swells and pushes the urethra, thus blocking urine flow and making the bladder not able to empty fully, is called benign prostatic hyperplasia (BPH). This causes the area to become one where microorganisms can develop more ‍‌‍‍‌‍‌‍‍‌easily.

Current‍‌‍‍‌‍‌‍‍‌ treatment guidelines for UTI in men

According to a study published on PubMed Central, treatment protocols for male urinary tract infections differ across various countries. A first-line treatment in the UK, Ireland, and Scotland mostly involves a seven-day course of trimethoprim or nitrofurantoin. In the case of patients with chronic kidney disease, drugs such as pivmecillinam or ciprofloxacin may be offered instead. The same set of standards is shared among several European countries. The decision to use second-line antibiotics is generally based on urine culture findings or employed when another diagnosis is suspected.

Why male UTIs are challenging to treat

Identification and treatment of UTIs in males are rather complicated as compared to females. Men less frequently present with UTIs, and the available evidence for treatment is of low quality. Consequently, many doctors and general practitioners consider male UTIs as “complicated” cases and thus, handle them with caution. Therefore, in most situations, they will prescribe broader-spectrum antibiotics or a longer course of treatment, which may not always be needed.

The majority of research and clinical guidelines point to the fact that UTIs in women are well recognised in terms of symptoms, diagnosis, and treatment duration. Nevertheless, for elder males, especially those with enlarged prostates, having urinary catheters, or living in hospitals or nursing homes, their rate of UTI is on par with that of females.


Unlike female urinary tract infections, very few randomised controlled trials (RCTs) have been done involving men with community-acquired UTIs treated in primary care. This scarcity of evidence has caused the guidance on antibiotic selection and treatment duration to be inconsistent. Typical symptoms of male urinary tract infections are urgency, frequent urination, painful urination, and nocturia. If treatment is delayed or wrong, bacteria may ascend and cause pyelonephritis, which is a serious infection of the kidney usually accompanied by fever and lower back ‍‌‍‍‌‍‌‍‍‌pain.