UTI in Men

Overview

Urinary tract infection (UTI) is commonly thought to be a woman’s disease. This is because bladder infection (cystitis), which is the most common UTI around, predominantly affects women. But infections in other parts of the urinary tract such as the urethra (urethritis) and the kidneys (pyelonephritis) affect men and women at the same rate. Men can develop a bladder infection too if they have certain risk factors. Since urine and semen share a common exit route in men, and organs involved in making semen are connected to the urethra, UTIs in men can also involve the prostate and epididymis.

Causes of UTI in Men

By the sheer virtue of its anatomical design the male urinary tract is protected from UTIs. First, the urethral opening in the penis is well removed from the anus, which is the commonest source of bacteria causing UTIs. Second, the male urethra is a long structure, so bacteria have to make an extended journey to reach the bladder and beyond. Together, these factors make a man’s urinary tract pretty safe from UTIs.  But they can occur if some additional risk factors are present.
  • UTI in a male makes doctors suspicious of an underlying defect:  Stones or an anatomical defect causing kinks or obstructions in the urinary tract can cause urine to pool and bacteria to flourish. They need to be corrected to ward off UTIs for good.
  • Men >50 years become prone because of prostate enlargement: The prostate gland in men hugs the urethra right where it joins the bladder. With age, this gland tends to grow in size and may squeeze the urethra leading to incomplete bladder emptying. The pooled urine becomes a breeding ground for bacteria making UTIs common in older men.
  • Anal intercourse increases risk: Though bacteria from a man’s own anal region can’t easily reach his urinary tract, he can contract them from his partner during anal intercourse. Homosexual men tend to contract bladder infection through this route. In rare instances, a man may contract intestinal bacteria during vaginal intercourse if they have taken root in his partner’s vagina.
  • Sexually transmitted urethritis is always a risk: Not using condoms, sex with a new partner or with multiple partners puts men at increased risk of sexually transmitted infections of the urethra. However, such infections mostly remain limited to the urethra and don’t move towards the bladder or kidneys. They tend to spread towards the epididymis, prostate and testis. For this reason, they are thought of more as an STD than a UTI.
  • Urinary catheterization is a big risk factor. Men undergoing urinary catheterization can contract UTIs because the catheter provides a direct channel of entry for the bacteria.

Symptoms of UTIs in Men

Urethral Infection (Urethritis): Urethritis in men is most often sexually-transmitted. It can occur at any age, but men in the 20 to 24 age group are most often affected. 

Symptoms:

  • Pain during urination
  • Pain felt primarily in and around the urethral opening
  • Worst pain when you pee first thing in the morning
  • More pain at the beginning of urination
  • Pain worsened after taking alcohol
  • Discharge from the urethra (milky, clear, yellow, green, brown, blood stained)
  • Itching or irritation in the urethra
  • Feeling of heaviness in the genitals
  • HSV may cause painful blisters in the genital area

Prostate Infection (Prostatitis): Prostate infections are a common cause of urinary symptoms in men of all ages and the commonest cause of recurrent UTI in men.

Symptoms:

  • Pain during urination
  • Urge too pee often and urgently
  • Feeling of incomplete emptying
  • Weak urine stream
  • Pain in the genital region
  • Fever with chills
  • General feeling of illness
  • Back and abdominal pain
  • Urethral discharge

Bladder infection (Cystitis): Cystitis in men less than 50 is rare, but can occur in the presence of risk factors discussed above. The risk increases markedly after 50.

Symptoms:

  • Pain during urination
  • Pain just above the pubic bone
  • Peeing more often
  • Need to pee urgently
  • Feeling as though more urine remains
  • Abdominal and back pain
  • General feeling of illness

Kidney infection (Pyelonephritis): Kidney infections in men and  women produce identical symptoms, such as:

  • Fever with chills
  • Nausea and vomiting
  • Flank and abdominal and back pain
  • General feeling of illness

Diagnosis and Treatment

  • If urethritis is suspected, your doctor may order a urethral smear, PCR and Ligase chain reaction tests for STDs. Some patients are treated without further testing if symptoms and history are in line with a sexually-transmitted infection.
  • Diagnosis of bladder and prostate infection requires urinalysis and urine culture. Additional imaging tests maybe done if an underlying defect in the urinary tract is suspected.
  • Antibiotics are needed to cure the infection. Men usually require a  longer duration of treatment than women.
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