Urinary tract infections, or UTIs, are often associated with women. But men can get UTIs too, and urinary symptoms should not simply be brushed off as part of getting older. A UTI can affect the bladder, urethra, kidneys or, in some men, the prostate. Symptoms may start with a burning sensation when passing urine or needing to urinate more often than usual. In some cases, however, an infection can progress and cause fever, back pain, vomiting or difficulty passing urine. Knowing the UTI symptoms in men can help you recognise an infection early and seek appropriate treatment.

Can men get urinary tract infections?

Men can develop urinary tract infections, although UTIs are less common in men than in women. A UTI occurs when microorganisms, most commonly bacteria, enter and multiply in part of the urinary tract. A bladder infection, also known as cystitis, is one type of UTI. Infection can also affect the urethra, kidneys or prostate.

The European Association of Urology’s current guidance distinguishes between localised UTIs, such as cystitis, and systemic UTIs, which can cause symptoms such as fever and may involve the kidneys or prostate. Because a UTI in a man may be associated with an underlying urinary or prostate problem, medical assessment is important rather than relying on self-treatment alone.

What are the common UTI symptoms in men?

The symptoms can vary depending on where the infection is located and how severe it is. Common male UTI symptoms include:

• A burning or painful sensation when urinating
• Needing to urinate more frequently
• A sudden or urgent need to urinate
• Passing only a small amount of urine
• Pain or discomfort in the lower abdomen
• Cloudy urine
• Strong-smelling urine
• Blood in the urine

These symptoms can occur with a bladder infection. However, urine that looks or smells different on its own does not necessarily mean you have a UTI. Dehydration and other urinary conditions can also change the appearance or smell of urine.

UTI symptoms and prostate problems can overlap

Men may sometimes mistake urinary symptoms caused by an enlarged prostate for a UTI, or vice versa. An enlarged prostate, known as benign prostatic hyperplasia (BPH), can narrow the urethra and make it harder to empty the bladder completely. Symptoms can include a weak urine stream, difficulty starting urination, frequent urination, urgency and dribbling. Incomplete bladder emptying can increase the risk of urinary tract infection. This is particularly relevant for older men. If urinary symptoms are persistent or keep returning, a doctor may need to look beyond the immediate infection to identify an underlying cause.

What are the warning signs of a serious UTI in men?

Some symptoms suggest that an infection may have moved beyond the bladder or may be affecting the prostate or kidneys. Seek prompt medical attention if urinary symptoms are accompanied by:

• Fever or chills
• Pain in the back, side or lower abdomen
• Nausea or vomiting
• Significant weakness or feeling very unwell
• Difficulty starting or maintaining urine flow
• Inability to pass urine
• Pain in the groin, genital area or between the scrotum and anus

Fever, chills, pelvic pain and urinary difficulties can occur with acute bacterial prostatitis, which requires prompt medical assessment. A bladder infection can also spread to the kidneys. Kidney infection symptoms may include fever, chills, nausea, vomiting and pain in the back, side or groin. Untreated kidney infections can lead to serious complications, including sepsis and kidney damage.  If you suddenly cannot urinate at all, seek emergency medical care. Acute urinary retention can cause severe pain and requires immediate treatment.

What causes UTIs in men?

Bacteria are the most common cause of bladder infections. Normally, urination helps remove bacteria from the urinary tract. Problems that prevent the bladder from emptying properly can make infection more likely.  Risk factors for UTIs in men include:

Sexually transmitted infections can also cause symptoms that resemble a UTI. Urethritis, for example, may cause burning during urination and discharge from the penis. Chlamydia and gonorrhoea are among the infectious causes of urethritis.  For sexually active men, particularly those with a new partner, unprotected sex or penile discharge, STI testing may therefore be appropriate.

UTI or something else? Why the distinction matters

Burning during urination does not automatically mean you have a UTI. Several conditions can cause similar symptoms, including:

• Urethritis, including sexually transmitted infections
• Bacterial prostatitis
• Enlarged prostate
• Kidney or bladder stones
• Urinary retention
• Other bladder or urinary tract conditions

For example, penile discharge is more suggestive of urethritis than a straightforward bladder infection and should prompt appropriate STI assessment where relevant. This is one reason why taking leftover antibiotics or using someone else’s medication is not a good approach. The correct treatment depends on the underlying cause.

How is a UTI diagnosed in men?

A healthcare professional will usually consider your symptoms, medical history and examination findings before deciding which tests are appropriate. A urinalysis can look for signs of infection, including white blood cells and blood. A urine culture can identify bacteria in the urine and help guide antibiotic treatment. Blood tests may be needed if a more serious or systemic infection is suspected.

Depending on your symptoms, your doctor may also investigate whether an enlarged prostate, urinary obstruction, kidney stone or another condition is contributing to the infection. Men with recurrent infections may require additional evaluation, which can include urinary tract imaging or other urological tests.

How are UTIs treated in men?

When a bacterial UTI is diagnosed, antibiotics may be prescribed. The choice of antibiotic depends on factors such as the suspected bacteria, local resistance patterns, previous culture results, allergies and whether the prostate may be involved.

Treatment should be guided by a healthcare professional rather than by using leftover antibiotics. The duration and choice of treatment can differ between patients. Infection involving the prostate can be more difficult to treat because antibiotics need to reach the prostate tissue effectively.  If antibiotics are prescribed, take them exactly as directed. Stopping treatment early or taking antibiotics unnecessarily can contribute to antibiotic resistance.

In Malaysia, responsible antibiotic use is also an important part of antimicrobial stewardship. The Ministry of Health Malaysia’s antimicrobial stewardship guidance emphasises appropriate assessment and antibiotic use in urinary tract infections.

How can men reduce their risk of UTIs?

There is no guaranteed way to prevent every UTI, but healthy urinary habits can help.Drink enough fluid for your individual needs, avoid regularly holding urine and take time to empty your bladder. If you have persistent difficulty emptying your bladder, discuss it with a healthcare professional rather than simply accepting it as a normal part of ageing.

For men with recurrent UTIs, identifying and treating an underlying problem, such as urinary retention, an enlarged prostate or a urinary stone, may be more important than simply treating each infection as it occurs.

The bottom line: Men can get UTIs too

A UTI is not exclusively a women’s health issue. Men can develop urinary tract infections, and symptoms such as burning urination, urinary frequency, urgency, lower abdominal discomfort or blood in the urine deserve attention. More concerning signs, including fever, chills, back or side pain, vomiting, severe pelvic pain or an inability to urinate, may indicate a more serious infection or prostate involvement.

If you are experiencing possible UTI symptoms in men, especially for the first time or alongside warning signs, seek medical advice. A proper diagnosis can distinguish a UTI from prostate problems, urinary obstruction, kidney stones or an STI and ensure that treatment is directed at the actual cause.

Reference:

• https://www.cdc.gov/std/treatment-guidelines/urethritis-and-cervicitis.htm
• https://uroweb.org/guidelines/urological-infections%C2%A0/summary-of-changes
• https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-infection-uti-in-adults