From the Guidelines
For a 24-year-old male experiencing frequent urinary tract infections (UTIs), it is crucial to consult a urologist for a thorough evaluation to identify and address any underlying complicating factors, as indicated in the 2024 European Association of Urology guidelines on urological infections 1. Given the potential for complicated urinary tract infections (cUTIs) in this scenario, the management should focus on appropriate antimicrobial therapy, taking into account the severity of the illness, local resistance patterns, and specific host factors such as allergies.
- The patient should undergo urine culture and susceptibility testing to guide the selection of an appropriate antimicrobial agent.
- Initial empiric therapy may be necessary, followed by tailored treatment based on the uropathogen isolated, with common species including E. coli, Proteus spp., Klebsiella spp., Pseudomonas spp., Serratia spp., and Enterococcus spp. 1.
- Treatment duration typically ranges from 7 to 14 days, with the possibility of shorter courses (e.g., 7 days) in certain cases where the patient is hemodynamically stable and has been afebrile for at least 48 hours 1. While awaiting the urologist's appointment, the patient can take preventive measures such as:
- Increasing fluid intake to at least 2-3 liters of water daily
- Urinating frequently and completely
- Urinating after sexual activity
- Considering over-the-counter D-mannose 1-2 grams daily to help prevent bacterial adhesion to the urinary tract It is essential to investigate potential underlying issues, which may include obstruction at any site in the urinary tract, recent history of instrumentation, or health care–associated infections, as outlined in the guidelines 1. Tests such as urinalysis, urine culture, ultrasound, or cystoscopy may be ordered to identify the cause of the recurrent UTIs.
From the Research
Urinary Tract Infections (UTIs) in Men
- UTIs can present in different patterns with variable degrees of severity, ranging from asymptomatic and uncomplicated forms to life-threatening complicated infections 2.
- The annual incidence of UTIs is 3% among men, with recurrent UTIs (defined as three in 1 year or two in 6 months) also being common 3.
Diagnosis of UTIs
- Clinical presentation helps differentiate between upper and lower urinary tract infections (UTIs), with primary laboratory tests consisting of urinalysis and urine culture 4.
- Different urine tests have varying specificity and sensitivity for UTI diagnosis, with bacterial culture being the gold standard for confirmation 5.
Management of UTIs in Men
- The management of adult male urinary tract infections (mUTIs) in primary care lacks international consensus, with different guidelines proposing various classifications and treatment approaches 6.
- Fluoroquinolones (FQ) are commonly recommended for febrile mUTIs, with a treatment duration of 10-14 days, while FQ-sparing treatments such as pivmecillinam, nitrofurantoin, or trimethoprim may be proposed for afebrile mUTIs 6.
Treatment Options
- Nitrofurantoin, fosfomycin, and trimethoprim-sulfamethoxazole are first-line therapies for acute uncomplicated cystitis, with decisions regarding antibiotic agents individualized based on patient factors such as allergies and community resistance rates 4.
- Effective prophylactic options for UTI include antibiotics and vaginal estrogen for postmenopausal women, although antibiotics are associated with a risk of increased drug resistance 3.