Can anal sex cause a Urinary Tract Infection (UTI) in men?

Anal Sex and UTI Risk in Males

Anal sex can cause urinary tract infections (UTIs) in men, particularly when they are the insertive partner, due to exposure to enteric bacteria from the rectum that can enter the urethra. 1

Mechanism and Risk Factors

• Epididymitis (a type of UTI affecting the epididymis) caused by sexually transmitted enteric organisms such as Escherichia coli occurs among men who are the insertive partner during anal intercourse 1
• The infecting uropathogens in UTIs originate from the fecal flora, with E. coli being the most predominant pathogen, accounting for 80-90% of these infections 2
• During anal intercourse, bacteria from the rectum can be transferred to the urethra of the insertive partner, potentially leading to infection 3
• Research has identified sexually active homosexual men as a group at increased risk of acute urinary tract infection, with E. coli strains showing properties associated with UTIs 3

Clinical Presentation

• Men with UTIs related to anal intercourse may present with:
  • Urethritis (inflammation of the urethra), which may be asymptomatic 1
  • Dysuria (painful urination) 3
  • Urinary frequency or urgency 3
  • Possible urethral discharge 3
  • In cases of epididymitis: unilateral testicular pain, tenderness, and palpable swelling of the epididymis 1

Diagnostic Considerations

For men presenting with suspected UTI after anal intercourse, evaluation should include:

• Gram-stained smear of urethral exudate or intraurethral swab specimen to diagnose urethritis and for presumptive diagnosis of gonococcal infection 1
• Culture of urethral exudate or intraurethral swab, or nucleic acid amplification test for N. gonorrhoeae and C. trachomatis 1
• Examination of first-void urine for leukocytes if the urethral Gram stain is negative 1
• Culture and Gram-stained smear of uncentrifuged urine for Gram-negative bacteria 1

Prevention Strategies

To reduce the risk of UTIs related to anal intercourse:

• Use latex condoms during every act of sexual intercourse, including anal intercourse 1
• Change condoms after anal intercourse before engaging in other sexual activities 1
• Urinate soon after sexual activity to help flush bacteria from the urethra 4
• Maintain good genital hygiene with frequent washing of hands and genitals with warm soapy water during and after activities that might bring these body parts in contact with feces 1
• Consider wearing latex gloves during digital-anal contact 1

Treatment Approaches

For UTIs related to anal intercourse, particularly epididymitis caused by enteric organisms:

• Ofloxacin 300 mg orally twice a day for 10 days OR Levofloxacin 500 mg orally once daily for 10 days 1
• For epididymitis with suspected gonococcal or chlamydial co-infection: Ceftriaxone 250 mg IM in a single dose PLUS Doxycycline 100 mg orally twice a day for 10 days 1
• Adjunct therapy includes bed rest, scrotal elevation (in cases of epididymitis), and analgesics until fever and local inflammation have subsided 1

Important Considerations

• Failure to improve within 3 days requires reevaluation of both diagnosis and therapy 1
• Persistent swelling and tenderness after completing antimicrobial therapy should be evaluated comprehensively 1
• The differential diagnosis for persistent symptoms includes tumor, abscess, infarction, testicular cancer, and tuberculous or fungal epididymitis 1
• For recurrent UTIs, consider evaluation for anatomical abnormalities of the urinary tract 5