Urinary tract infections in men

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 5 Jun 2025

Last updated: 26 Feb 2025

Urinary tract infection (UTI) in men rarely occurs before 50 years of age.

Often associated with abnormal structure or function of the urinary tract (complicated UTI).

Catheter-associated UTI is the most common cause of nosocomial infection.

Imaging of the urinary tract is recommended for men with persistent hematuria, voiding dysfunction without a clearly identifiable cause such as benign prostatic hyperplasia (BPH), failure of initial therapy, or signs of upper tract infection.

Treatment with a fluoroquinolone antibiotic is generally appropriate in men as they are likely to have a UTI classified as complicated. Asymptomatic bacteriuria does not require treatment except before urologic procedures.

Definition

UTI is an inflammatory reaction of the urinary tract epithelium in response to pathogenic microorganisms, most commonly bacteria.

History and exam

Key diagnostic factors

dysuria
urgency
frequency
suprapubic pain
costovertebral angle pain

Full details

Other diagnostic factors

hesitancy
nocturia
enlarged prostate
tender prostate
rectal/perineal pain
fever/rigors
urethral discharge

Full details

Risk factors

benign prostatic hypertrophy
urinary tract stones
urologic surgery, instrumentation
urethral strictures
age >50
previous UTI
catheterization
anal sex
vaginal sex
recent hospitalization
uncircumcised

Full details

Diagnostic tests

1st tests to order

dipstick urinalysis (U/A)
urine microscopy
urine culture
Gram stain

Full details

Tests to consider

CT renal tract
ultrasound
plain x-ray kidneys, ureters, and bladder (KUB)
intravenous urogram (IVU)

Full details

Treatment algorithm

INITIAL

asymptomatic bacteriuria before urologic procedure

ACUTE

not severe and tolerating oral therapy

severe or not tolerating oral therapy

Contributors

Authors

Timothy J. Benton, MD

Regional Chairman

Residency Program Director

Associate Professor

Department of Family and Community Medicine

Texas Tech University Health Sciences Center

Permian Basin Campus

Odessa

Disclosures

TJB declares that he has no competing interests.

Peer reviewers

Catherine DuBeau, MD

Professor of Medicine

Dartmouth Hitchcock Medical Center

Lebanon

Disclosures

CD is a member of the American Geriatrics Society Revision Panel for the Beers criteria for potentially inappropriate medications in older persons; planning committee, speaker, and manuscript co-author for the American Urogynecological Association State of the Science on OAB and cognition; and co-investigator, RELIEF trial (botulinum toxin for refractory overactive bladder in older women, funded by PCORI.

Richard Viken, MD

Professor of Family Medicine and Chairman of the Department of Family Medicine

University of Texas Health Sciences Center

Tyler

Disclosures

RV declares that he has no competing interests.

Robert Pickard, MD, FRCS (Urol)

Professor of Urology

Institute of Cellular Medicine

Newcastle University

Newcastle upon Tyne

Disclosures

RP declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Nicolle LE, Gupta K, Bradley SF, et al. Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2019 May 2;68(10):e83-e110.Full text Abstract

Kranz J, Bartoletti R, Bruyère F, et al. European Association of urology guidelines on urological infections: summary of the 2024 guidelines. Eur Urol. 2024 Jul;86(1):27-41.Full text Abstract

European Association of Urology. Guidelines on urological infections. Apr 2024 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Benign prostatic hypertrophy (BPH)
- Prostatitis
- Pyelonephritis
More Differentials
Guidelines
- Guidelines on urological infections
- Urinary tract infection (recurrent): antimicrobial prescribing
More Guidelines
Patient information
Urinary tract infections in men
More Patient information
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Urinary tract infections in men

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Treatment algorithm

asymptomatic bacteriuria before urologic procedure

not severe and tolerating oral therapy

severe or not tolerating oral therapy

Contributors

Authors

Timothy J. Benton, MD

Disclosures

Peer reviewers

Catherine DuBeau, MD

Disclosures

Richard Viken, MD

Disclosures

Robert Pickard, MD, FRCS (Urol)

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Patient information

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice