Can Men Get Urinary Tract Infections?

Yes, men can and do get urinary tract infections (UTIs), but they get them much less frequently than women, and usually in conjunction with some other condition.

UTI is a generic term that includes both infections in the kidneys, called pyelonephritis, and those in the bladder, called cystitis. Pyelonephritis is not common in either sex, but can be a severe infection with high fever, flank or mid-back pain, burning on urination, and occasionally with blood appearing in the urine. Cystitis on the other hand is limited to the bladder and seldom produces fever or back pain, but is usually accompanied by several symptoms: dysuria, burning on urination; urgency, the sensation that one must go quickly or risk losing the urine; frequency, having frequent small-volume urinations; and blood in the urine.

Women may have confusing symptoms of burning on urination when in fact they have an inflammation of the vagina such as a yeast infection, and the acid urine burns when it contacts the irritated vaginal mucosa. This can usually be distinguished from cystitis because there is no urgency, no frequency, and a clean catch urinalysis should not show signs of infection.

Why is cystitis so common in women, and not common in men? Is this a sexually transmitted disease? In women, cystitis is frequently a condition that follows sexual activity, but it is not considered sexually transmitted. The distinction is that the bacteria causing most cases of cystitis in a woman are the same bacteria that all people normally have around their genitals and the surrounding skin. These are E. coli, and it is believed that women develop cystitis following sex because the bacteria that they normally carry are pushed up into the urethra and bladder by the friction of intercourse. In other words, they are not catching an infection with bacteria that are only transmitted through sex, they are catching an infection caused by their own bacteria which sex has enabled to get into the bladder, a normally sterile environment. Because the bacteria come from their own bodies, women can and frequently do get UTIs even when their partners are practicing safe sex and wearing condoms.

A woman’s urethra, the tube leading from the bladder to the outside through which we urinate, is quite short, about two to three centimeters in length. A man’s urethra, in contrast, is over 12 centimeters long. This greater length protects men against any bacteria that may try to grow up this long urethra. Passing acid urine tends to flush out the urethra and keep it sterile for most of its length. Women simply don’t have a sufficiently long urethra to provide this protection. Using a diaphragm and spermicides such as Nonoxynol-9 may increase the chances of a woman getting a UTI after sex. If a woman has frequent UTIs related to sexual activity, her doctor may prescribe an antibiotic to be taken following sex, or occasionally every day.

When men get a UTI, it is usually because of some anatomical change in their urinary tract. The most common of these is prostate enlargement, either from benign prostatic hypertrophy or from prostate cancer. Burning on urination with urgency, frequency and blood in the urine is a common first sign of one of these conditions. A second condition which can lead to UTIs in both men and women is the presence of a stone, either in the kidneys, the ureters or the bladder. Large stones in the kidneys, called staghorn calculi because of their shape, will frequently become infected, and these infections are very difficult to cure because the presence of the stone provides the bacteria with hiding places where antibiotics cannot reach them. In such cases the stones must either be removed through surgery or lithotripsy, or if this is not possible, steps like acidifying the urine and giving a urinary antiseptic which will suppress bacterial growth are necessary.

In men, gonorrhea and to a lesser extent chlamydia, both STDs, can cause burning on urination similar to cystitis, but as in the case of women with vaginitis, they will usually not have the UTI symptoms of urgency and frequency, and they will often have a penile discharge, drops of pus that ooze out and soil the underwear or bedclothes. Both of these infections should of course be diagnosed and treated quickly, since they are very easily transmitted through sex. Condom use will almost totally prevent transmission of these two STDs as well as life-threatening STDs like HIV and hepatitis B.

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