Can males get urinary tract infections (UTIs)?

Urinary Tract Infections in Males

Yes, males can definitely get urinary tract infections (UTIs), though they occur less frequently in men than in women. While UTIs are approximately 30 times more common in adult women, men are still susceptible to these infections, with about 12% of men experiencing at least one symptomatic UTI during their lifetime 1, 2.

Epidemiology and Risk Factors

• Age-related risk:

  • In infants and young children: Uncircumcised boys have significantly higher risk (8% prevalence) compared to circumcised boys (1.2%) under age 1 3
  • In adult men: UTI prevalence increases with age, with a median age of 61 years in symptomatic men 4

• Key risk factors in males:

  • Uncircumcised status (particularly in infants and young boys) 3
  • Prostatic hypertrophy (major predisposition in older men) 5
  • Genitourinary instrumentation 5
  • Anatomical or functional abnormalities of the urinary tract 6
  • Indwelling urinary catheters 6
  • Age < 6 months in male infants 3

Clinical Presentation

Males with UTIs typically present with:

• Dysuria (burning on urination)
• Urinary frequency
• Fever/sweats (more common in males than females)
• Hematuria
• Multiple concurrent symptoms are common 7

In young children, symptoms may be nonspecific:

• Fever (most common symptom in infants)
• Vomiting
• Diarrhea
• Irritability
• Poor feeding 3

Diagnosis

1. Urine analysis and culture:

   • Leukocyte esterase (sensitivity 72-97%, specificity 41-86%)
   • Nitrites (sensitivity 19-48%, specificity 92-100%) 6
   • Urine culture is the reference standard for confirmation 6

2. Important diagnostic considerations for males:

   • Low colony count UTIs are common in men and should not be dismissed
   • Significant infection threshold: ≥10³ colony-forming units/mL (lower than the traditional threshold for women) 5
   • Dipstick tests have limited value in men (leukocytes: sensitivity 54%, specificity 55%; nitrite: sensitivity 38%, specificity 84%) 4

Treatment Approach

Men with symptoms indicative of UTI should not be treated empirically but should have a urine culture and antibiogram obtained before treatment decisions are made 4.

Antibiotic Selection:

• First-line options (based on culture results):

  • Amoxicillin-clavulanic acid (WHO recommendation) 6
  • Trimethoprim-sulfamethoxazole (when local resistance <20%) 6
  • Nitrofurantoin 6

• For complicated UTIs or when first-line options cannot be used:

  • Fluoroquinolones (e.g., levofloxacin) 6
  • Adjust dosing based on renal function 6

Treatment Duration:

• Single-dose therapy is inadequate for men 5
• Uncomplicated UTIs: 7-14 days of appropriate antibiotics 6
• Recurrent infections: At least 6 weeks of appropriate treatment 5

Special Considerations

• Epididymitis: Often accompanies UTI in sexually active men <35 years

  • Treatment regimen for suspected gonococcal/chlamydial cause:
    • Ceftriaxone 250 mg IM (single dose) PLUS
    • Doxycycline 100 mg orally twice daily for 10 days 3

• Further investigation is warranted for:

  • Young boys with UTI
  • Men with recurrent or complicated infections
  • Persistent symptoms despite treatment 5

Pitfalls to Avoid

1. Diagnostic pitfalls:

   • Relying solely on dipstick tests (poor sensitivity/specificity in men) 4
   • Dismissing low colony count infections 4
   • Failing to consider epididymitis in sexually active young men 3

2. Treatment pitfalls:

   • Using single-dose or short-course therapy (inadequate for men) 5
   • Empiric treatment without culture (high resistance rates make this approach problematic) 4
   • Using broad-spectrum antibiotics when narrow-spectrum options would be effective 6

3. Follow-up pitfalls:

   • Failing to consider underlying anatomical abnormalities in men with UTI 5
   • Not adjusting therapy based on culture results 6

Remember that UTIs in men are often complicated by underlying structural or functional abnormalities, making proper diagnosis, appropriate antibiotic selection based on culture results, and adequate treatment duration essential for successful outcomes.