Do uncircumcised males have a higher incidence of urinary tract infection than circumcised males?

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Uncircumcised Males Have Substantially Higher UTI Risk

Yes, uncircumcised men get UTIs significantly more often than circumcised men, with the highest risk occurring in infancy but persisting throughout life. The American Academy of Pediatrics confirms an approximately threefold to fourfold decreased risk of UTI among circumcised boys, with this protective effect being most pronounced in younger children. 1

Magnitude of Risk by Age Group

Infancy (0-1 Year)

  • Uncircumcised infant boys face a 9.91-fold higher risk of UTI compared to circumcised boys (95% CI: 7.49-13.1), making this the highest-risk period. 2
  • In febrile infants with no other risk factors, the baseline UTI probability is 2.1% for uncircumcised boys versus only 0.2% for circumcised boys. 1
  • The risk for uncircumcised boys never decreases below 2% even in the absence of other risk factors, while circumcised boys maintain risk below 1% unless multiple additional risk factors are present. 1
  • Being uncircumcised carries a likelihood ratio of 2.8 for UTI, meaning it nearly triples the baseline risk. 1

Childhood (1-16 Years)

  • The relative risk remains elevated at 6.56-fold (95% CI: 3.26-13.2) for uncircumcised boys compared to circumcised boys during childhood. 2
  • Boys more than 1 year of age who are circumcised have sufficiently low UTI risk (<1%) that routine evaluation may not be cost-effective in this population. 1

Adulthood (>16 Years)

  • Even in adulthood, uncircumcised males maintain a 3.41-fold higher risk (95% CI: 0.916-12.7), though the confidence interval is wider due to fewer studies. 2

Lifetime Cumulative Risk

The lifetime prevalence of UTI is 32.1% (95% CI: 15.6-49.8%) in uncircumcised males compared to only 8.8% (95% CI: 4.15-13.2%) in circumcised males, yielding a relative risk of 3.65 (95% CI: 1.15-11.8). 2 This translates to a 23.3% absolute increase in lifetime UTI risk attributable solely to lack of circumcision. 2

The number needed to treat (circumcise) to prevent one UTI is 4.29 (95% CI: 2.20-27.2). 2 Alternatively, 195 circumcisions would be needed to prevent one hospital admission for UTI in the first year of life specifically. 3

Biological Mechanism

The increased risk stems from higher colonization of uropathogens in the periurethral area of uncircumcised males:

  • Pure cultures of facultative Gram-negative rods (typical uropathogens) are significantly more common in uncircumcised males (17% vs 4% in circumcised males, p=0.01). 4
  • The subpreputial space serves as a reservoir for potential uropathogens, with streptococci, strict anaerobes, and genital mycoplasmas found almost exclusively in uncircumcised males over 15 years of age. 4
  • During the first six months of life, the foreskin is associated with both greater quantity and higher concentration of uropathogens in the periurethral area. 4

Special Consideration: Foreskin Retractability

Among uncircumcised boys with vesicoureteral reflux (VUR), those with retractable foreskin (phimosis grades 0-3) have dramatically lower UTI rates (4%) compared to those with non-retractable foreskin (phimosis grades 4-5, with 29% UTI rate). 5 Boys with high-grade phimosis have an 8.4-fold higher risk of UTI compared to those with retractable foreskin (HR=8.4,95% CI: 1.1-64, p=0.04). 5

Clinical Implications

For Febrile Infants

When evaluating febrile infant boys, circumcision status must be factored into clinical decision-making:

  • With 4 risk factors present (temperature >39°C, fever >24 hours, no apparent source, nonblack race), uncircumcised boys have a 25.6% probability of UTI versus only 3.7% in circumcised boys. 1
  • Even with zero risk factors, uncircumcised boys maintain a 2.1% UTI probability, which exceeds the 1% threshold typically used to justify urine testing. 1

Common Pitfalls to Avoid

  • Do not dismiss the need for urine testing in uncircumcised infant boys with fever, even when other risk factors are absent—their baseline risk already exceeds clinical thresholds for evaluation. 1
  • Do not assume that UTI risk normalizes after infancy—the elevated risk persists throughout childhood and into adulthood, though the magnitude decreases. 2
  • For uncircumcised boys with recurrent UTIs, consider evaluating foreskin retractability as a modifiable risk factor before pursuing more invasive interventions. 5

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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