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ERROR: type should be string, got "https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMjMxNTc0LWNsaW5pY2Fs\nDrugs & Diseases > Infectious Diseases\nUrinary Tract Infection (UTI) in Males Clinical Presentation\nAuthor: John L Brusch, MD, FACP; Chief Editor: Michael Stuart Bronze, MD more...\nUrinary Tract Infection (UTI) in Males\nSections Urinary Tract Infection (UTI) in Males\nProstatitis Syndromes\nEpididymitis and Cystitis\nUrethritis\nCatheterized and Hospitalized Patients\nUrine Studies\nPyuria Workup\nProstatitis Workup\nEpididymitis and Orchitis Workup\nCystitis Workup\nUrethritis Workup\nOutpatient Versus Inpatient UTI Management\nOverview of Prostatitis Treatment\nAcute and Chronic Prostatitis Therapy\nEpididymitis Therapy\nPyelonephritis Therapy\nOrchitis, Cystitis, and Urethritis Therapy\nUTI Prevention\nAnalgesics, Urinary\nIn men, the most frequent chief complaint related to urinary tract infection (UTI) is dysuria. In fact, complaints of dysuria, urinary frequency, and urgency are approximately 75% predictive for UTI, whereas the acute onset of hesitancy, urinary dribbling, and slow stream are only approximately 33% predictive for it. Other aspects to inquire about include the following:\nPrevious UTI(s)\nNocturia, gross hematuria, any changes in the color and/or consistency of the urine\nProstatic enlargement\nUrinary tract abnormalities - Personally and within their families\nComorbid conditions - Eg, diabetes\nHuman immunodeficiency virus (HIV) status\nImmunosuppressive treatments for other conditions - Eg, prednisone\nAny previous surgeries or instrumentation involving the urinary tract\nIn a younger man, the presence of UTI is often associated with anatomic abnormality. In the absence of this history, a detailed sexual history may implicate activities such as sex with a new partner, sex with multiple partners, or other risk-taking behavior associated with sexually transmitted disease (STD)-related urethritis, prostatitis, or epididymitis that may lead to UTI.\nCertain patients are at increased risk of urosepsis and complications, such as the very sick and the immunosuppressed, as well as those with a history of genitourinary surgery, a neurogenic bladder, papillary necrosis (sickle cell disease, diabetes, or analgesic abuse), and a history of ureteral stricture or tumor with obstruction.\nMales who present with genitourinary complaints warrant a thorough general physical examination, with particular attention to the vital signs, kidneys, bladder, prostate, and external genitalia.\nAuscultation over the upper abdominal quadrants and the costovertebral angles may reveal the bruits of renal artery stenosis, an aneurysm, or an arteriovenous malformation. The costovertebral angles should also be percussed for tenderness. Palpation of the suprapubic area should be performed; a bladder that contains 500mL or more of fluid is often palpable as a suprapubic mass.\nThe external genitalia should be examined carefully. The penis should be examined for the presence of ulcers or lesions, and special attention should be paid to the urethral meatus for the presence of erythema or discharge. The testes and epididymis must be examined and palpated for tenderness and swelling.\nA rectal examination with a 360° sweep of the interior of the rectum followed by careful palpation of the prostate can be performed. However, in patients with suspected acute bacterial prostatitis, palpation can be painful and may lead to bacteremia. Some authorities note that it is of little benefit in diagnosing acute prostatitis and state that prostatic massage should not be conducted in the setting of UTI or urethritis.\nPhysical findings of UTI may include the following:\nFlank pain/costovertebral angle tenderness\nAbdominal tenderness in the suprapubic area\nScrotal hematoma, hydrocele, masses, or tenderness\nMeatal discharge\nProstatic tenderness\nInguinal adenopathy\nThese syndromes tend to occur in young and middle-aged men. Symptoms may include pain (in the perineum, lower abdomen, testicles, or penis or with ejaculation), bladder irritation, and, sometimes, blood in the semen.\nAcute prostatitis typically presents with spiking fever, chills, malaise, myalgia, dysuria, pelvic or perineal pain, and cloudy urine. Obstructive symptoms can result from swelling of the acutely inflamed prostate, and these range from dribbling and hesitancy to anuria. A less common presentation is with a vague, flulike illness.\nCareful examination of the prostate is not contraindicated in acute bacterial prostatitis, but prostatic massage is contraindicated. Upon examination, the prostate is warm, swollen, soft (\"boggy\"), and extremely tender. The patient may have a fever and appear acutely uncomfortable; hypotension may be noted.\nPatients with chronic prostatitis, by definition, have had symptoms for at least 3 months. Although this condition is not life threatening, the patient's quality of life has been compared with someone with unstable angina or active Crohn disease. Interestingly, many men with chronic bacterial prostatitis are asymptomatic.\nChronic bacterial prostatitis and nonbacterial prostatitis have similar presentations, including dysuria, frequency, urgency, perineal discomfort, and a low-grade temperature. The only way to differentiate between these 2 entities is through culture of prostatic secretions.\nProstatodynia, a noninflammatory disorder, also has a symptom complex similar to that of chronic prostatitis, except that the patient does not give a history of recurrent UTIs.\nIn chronic bacterial prostatitis, the physical findings are variable. A low-grade fever may be present, and the rectal examination may be unremarkable or may reveal severe anal sphincter spasm. The prostate may be mildly or extremely tender.\nExamination of urine voided after prostate massage is more helpful diagnostically than quantitating the amount of pain experienced during the digital examination. The Meares-Stamey 4-glass test with prostatic massage is a classic diagnostic test for chronic prostatitis. Prostatic massage should not be conducted in the setting of UTI or urethritis.\nIn early epididymitis, the epididymis is tender and indurated, but the testis itself is nontender and soft. In hours to days, inflammation progresses to the adjacent testicle and patients may complain of scrotal pain and swelling, as well as urinary frequency, urgency, or dysuria. Identifying the lateral sulcus between the testicle and epididymis then becomes increasingly difficult, and discerning testis from epididymis may be impossible.\nDysuria, frequency, urgency, and suprapubic pain usually are present in patients with cystitis. Fever and flank pain may be present, but not usually. Note that symptoms cannot reproducibly differentiate cystitis (lower UTI) from pyelonephritis (upper UTI).\nThe most common presentation of orchitis is in a patient in the later stages of epididymitis. In this situation, inflammation has spread to the adjacent testicle and results in a tender, warm, and swollen hemi-scrotal mass. Patients have the characteristic history and urinary findings of epididymitis.\nOf patients with orchitis resulting from tuberculosis, 70% have other genitourinary or pulmonary symptoms of this disease.\nViral orchitis is notable for the symptoms of the viral syndrome. Orchitis occurs in approximately 18% of postpubertal boys infected with the mumps virus; symptoms usually begin within 1 week of parotitis. Up to 30% of cases are bilateral, and sterility develops in up to 10% of cases.\nPatients with pyelonephritis appear ill; have fever, chills, and flank pain; and may have hypotension. Although fever is very suggestive of pyelonephritis, it has also been demonstrated in some males with simple cystitis. Note that 30-50% of pyelonephritis cases may be silent, without clinical symptoms.\nIn the older male, prostate enlargement along with delayed presentation are the primary causes of pyelonephritis. Other historical risk factors include nephrolithiasis, neurogenic bladder, prostatitis, or symptom duration greater than 5 days.\nClassic findings with pyelonephritis include fever, chills, and flank pain/costovertebral angle tenderness that follow the symptoms of UTI; these findings are combined with pyuria and bacteriuria. Occasionally, the urinalysis and urine culture findings are negative, such as when an obstruction of the upper urinary tract is present due to stone disease.\nThe differential diagnoses include appendicitis, diverticulitis, pancreatitis, and lower-lobe pneumonia.\nThe incubation period of gonococcal urethritis is 2-6 days. Occasionally, 2 weeks may elapse before symptoms such as dysuria; thick, milky discharge; and pruritus occur.\nThe incubation period of nongonococcal urethritis (NGU) is 2-6 weeks. The symptoms are less severe and the discharge may be clearer than with gonococcal urethritis. Patients are likely to have a higher level of education (ie, 90% of urethritis cases in college health services is NGU) and fewer sexual contacts.\nBecause patients with urethritis have a thick, milky discharge, the underpants may be impressively stained. Typically, patients with gonorrhea have a thicker, more copious discharge, but significant overlap with chlamydial urethritis is not uncommon.\nGram stain is the key to an immediate diagnosis, although patients frequently have co-infections.\nClinical and microbiologic criteria for the diagnosis of UTI are not well established in catheterized hospitalized patients. Symptoms in these individuals may be atypical or may be attributed to other disease processes, and no reliable colony count cutoff defines significant bacteriuria.\nLow-level (100-1000 colony-forming units [CFU] per mL) colonization can progress to high-level (>100,000 CFU/mL) bacteriuria within 3 days in 96% of catheterized patients who are cultured on subsequent days (and not treated with antimicrobials). Thus, most experts agree that growth of more than 100 CFU/mL of a predominant pathogen represents catheter-associated UTI (CAUTI).\nLafon T, Hernandez Padilla AC, Baisse A, Lavaud L, Goudelin M, Barraud O, et al. Community-acquired Staphylococcus aureus bacteriuria: a warning microbiological marker for infective endocarditis?. BMC Infect Dis. 2019 Jun 7. 19 (1):504. [Medline].\nSante L, Aguirre-Jaime A, Miguel MA, Ramos MJ, Pedroso Y, Lecuona M. Epidemiological study of secondary bloodstream infections: The forgotten issue. J Infect Public Health. 2019 Jan - Feb. 12 (1):37-42. [Medline].\nDoluoglu OG, Gokkaya CS, Aktas BK, et al. Impact of asymptomatic prostatitis on re-operations due to urethral stricture or bladder neck contracture developed after TUR-P. Int Urol Nephrol. 2012 Jan 18. [Medline].\nvan der Starre WE, van Nieuwkoop C, Paltansing S, et al. Risk factors for fluoroquinolone-resistant Escherichia coli in adults with community-onset febrile urinary tract infection. J Antimicrob Chemother. 2011 Mar. 66(3):650-6. [Medline].\nMeares EM, Stamey TA. Bacteriologic localization patterns in bacterial prostatitis and urethritis. Invest Urol. 1968 Mar. 5(5):492-518. [Medline].\nChung SD, Keller JJ, Lin HC. A case-control study of chronic prostatitis/chronic pelvic pain syndrome and colorectal cancer. BJU Int. 2012 Feb 7. [Medline].\nFoxman B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Am J Med. 2002 Jul 8. 113 Suppl 1A:5S-13S. [Medline].\nJohnson JR. Laboratory diagnosis of urinary tract infections in adult patients. Clin Infect Dis. 2004 Sep 15. 39(6):873; author reply 873-4. [Medline].\nChiang IN, Chang SJ, Pu YS, Huang KH, Yu HJ, Huang CY. Major complications and associated risk factors of transrectal ultrasound guided prostate needle biopsy: a retrospective study of 1875 cases in Taiwan. J Formos Med Assoc. 2007 Nov. 106(11):929-34. [Medline].\nNickel JC. The Pre and Post Massage Test (PPMT): a simple screen for prostatitis. Tech Urol. 1997 Spring. 3(1):38-43. [Medline].\nDaunt SW. Accuracy of ultrasonography and plain-film abdominal radiography in the diagnosis of urologic abnormalities in men with urinary tract infection: critically appraised topic. Can Assoc Radiol J. 2004 Feb. 55(1):16-7. [Medline].\nGuay DR. Contemporary management of uncomplicated urinary tract infections. Drugs. 2008. 68(9):1169-205. [Medline].\nHowes DS, Bogner MP. Urinary tract infections. Tintinalli JE, Kelen GD, Stapczyski JS, eds. Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York, NY: McGraw-Hill; 2008.\nTalan DA, Krishnadasan A, Abrahamian FM, Stamm WE, Moran GJ. Prevalence and risk factor analysis of trimethoprim-sulfamethoxazole- and fluoroquinolone-resistant Escherichia coli infection among emergency department patients with pyelonephritis. Clin Infect Dis. 2008 Nov 1. 47(9):1150-8. [Medline].\nCunha BA. Antibiotic Essentials. 7th ed. Royal Oak, Mich: Physicians Press.; 2008.\nKillgore KM, March KL, Guglielmo BJ. Risk factors for community-acquired ciprofloxacin-resistant Escherichia coli urinary tract infection. Ann Pharmacother. 2004 Jul-Aug. 38(7-8):1148-52. [Medline].\n[Guideline] Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep. 2006 Aug 4. 55:1-94. [Medline]. [Full Text].\nDouglas D. Tadalafil confirmed as helpful in LUTS/BPH. Reuters Health Information. August 20, 2013. Available at http://www.medscape.com/viewarticle/809664. Accessed: August 29, 2013.\nWagenlehner FM, Naber KG. Fluoroquinolone Antimicrobial Agents in the Treatment of Prostatitis and Recurrent Urinary Tract Infections in Men. Curr Infect Dis Rep. 2005 Jan. 7(1):9-16. [Medline].\nWagenlehner FM, Naber KG. Current challenges in the treatment of complicated urinary tract infections and prostatitis. Clin Microbiol Infect. 2006 May. 12 Suppl 3:67-80. [Medline].\nLuzzi G. Chronic prostatitis. N Engl J Med. 2007 Jan 25. 356(4):423-4; author reply 424. [Medline].\nWagenlehner FM, Weidner W, Naber KG. Therapy for prostatitis, with emphasis on bacterial prostatitis. Expert Opin Pharmacother. 2007 Aug. 8(11):1667-74. [Medline].\nYoon BI, Kim S, Han DS, et al. Acute bacterial prostatitis: how to prevent and manage chronic infection?. J Infect Chemother. 2012 Jan 5. [Medline].\n[Guideline] Hooton TM, Bradley SF, Cardenas DD, Colgan R, Geerlings SE, Rice JC, et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 2010 Mar 1. 50(5):625-63. [Medline]. [Full Text].\n[Guideline] Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA. Guideline for prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol. 2010 Apr. 31(4):319-26. [Medline]. [Full Text].\nSaint S, Elmore JG, Sullivan SD, Emerson SS, Koepsell TD. The efficacy of silver alloy-coated urinary catheters in preventing urinary tract infection: a meta-analysis. Am J Med. 1998 Sep. 105(3):236-41. [Medline].\n[Guideline] Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015 Jun 5. 64 (RR-03):1-137. [Medline]. [Full Text].\nGermanos GJ, Trautner BW, Zoorob RJ, Salemi JL, Drekonja D, Gupta K, et al. No Clinical Benefit to Treating Male Urinary Tract Infection Longer Than Seven Days: An Outpatient Database Study. Open Forum Infect Dis. 2019 Jun. 6 (6):ofz216. [Medline].\nAnesi JA, Lautenbach E, Nachamkin I, Garrigan C, Bilker WB, Omorogbe J, et al. The role of extended-spectrum cephalosporin-resistance in recurrent community-onset Enterobacteriaceae urinary tract infections: a retrospective cohort study. BMC Infect Dis. 2019 Feb 14. 19 (1):163. [Medline].\nMcNaughton Collins M, Fowler FJ Jr, Elliott DB, Albertsen PC, Barry MJ. Diagnosing and treating chronic prostatitis: do urologists use the four-glass test?. Urology. 2000 Mar. 55(3):403-7. [Medline].\nPorst H, Oelke M, Goldfischer ER, Cox D, Watts S, Dey D, et al. Efficacy and Safety of Tadalafil 5 mg Once Daily for Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia: Subgroup Analyses of Pooled Data From 4 Multinational, Randomized, Placebo-controlled Clinical Studies. Urology. 2013 Jul 19. [Medline].\nOlson PD, Hruska KA, Hunstad DA. Androgens Enhance Male Urinary Tract Infection Severity in a New Model. J Am Soc Nephrol. 2015 Oct 8. [Medline].\nProstatic calcifications in a male with a urinary tract infection.\nBladder calculi in a male with a urinary tract infection.\nJohn L Brusch, MD, FACP Assistant Professor of Medicine, Harvard Medical School; Consulting Staff, Department of Medicine and Infectious Disease Service, Cambridge Health Alliance\nJohn L Brusch, MD, FACP is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America\nBurke A Cunha, MD Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital\nBurke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, Infectious Diseases Society of America\nMichael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London\nMichael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical Investigation\nBryan P Blair, MD Staff Physician, Department of Urology, Naval Medical Center at Portsmouth\nDavid S Howes, MD Professor of Medicine and Pediatrics, Section Chief and Emergency Medicine Residency Program Director, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine\nDavid S Howes, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physicians-American Society of Internal Medicine, and Society for Academic Emergency Medicine\nKlaus-Dieter Lessnau, MD, FCCP Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory; Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital\nKlaus-Dieter Lessnau, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Thoracic Society, and Society of Critical Care Medicine\nDisclosure: Sepracor None None\nMark Jeffrey Noble, MD Consulting Staff, Urologic Institute, Cleveland Clinic Foundation\nMark Jeffrey Noble, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Kansas Medical Society, Sigma Xi, Society of University Urologists, and Southwest Oncology Group\nM Tyson Pillow, MD Assistant Director of Medical Education, Ben Taub General Hospital Emergency Center; Assistant Professor, Baylor College of Medicine\nM Tyson Pillow, MD is a member of the following medical societies: Air Medical Physician Association, American College of Emergency Physicians, American Medical Association, American Medical Student Association/Foundation, Emergency Medicine Residents Association, Society for Academic Emergency Medicine, and Student National Medical Association\nJoseph A Salomone III, MD Associate Professor and Attending Staff, Truman Medical Centers, University of Missouri-Kansas City School of Medicine; EMS Medical Director, Kansas City, Missouri\nJoseph A Salomone III, MD is a member of the following medical societies: American Academy of Emergency Medicine, National Association of EMS Physicians, and Society for Academic Emergency Medicine\nRichard H Sinert, DO Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center\nRichard H Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic Emergency Medicine\nCindy L Tamminga, MD Consulting Staff, Division of Infectious Diseases, Naval Medical Center at Portsmouth\nencoded search term (Urinary Tract Infection (UTI) in Males) and Urinary Tract Infection (UTI) in Males\nUrinary Tract Infection (UTI) and Cystitis (Bladder Infection) in Females\nPrevention of Urinary Tract Infection (UTI)\nCatheter-Related Urinary Tract Infection (UTI)\nUrinary Tract Infections (UTI) in Diabetes Mellitus\nPrevention of Urinary Tract Infection (UTI) in Women\nPathophysiology of Complicated Urinary Tract Infection (UTI)\nFebrile Infant With Rhinovirus: Can You Really Stop Looking for a Bacterial Infection?\nRace Should Not Limit Urinary Tract Infection Workup in Young Febrile Children\nNew AHA Statement on Management of Fulminant Myocarditis\nUrinary Tract Infections: A Spectrum of Pathologies and Challenges\nAccording to Infectious Disease Physicians\nFlu Rates Rising, Pediatric Deaths Double Compared to 2018: CDC\nFlu Can Be Catastrophic in Older Patients: 5 Things to Know\nAlice in Wonderland Syndrome: What Can It Reveal?\nFecal Transplant Transmits Fatal Drug-Resistant E coli Infection\nTwo Drugs Better Than One for Severe Influenza\nDiseases & Conditions Pediatric Urinary Tract Infection\nDiseases & Conditions Urinary Tract Infection (UTI) and Cystitis (Bladder Infection) in Females\n2002 2040239-overview Diseases & Conditions\nDiseases & Conditions Prevention of Urinary Tract Infection (UTI)\nDiseases & Conditions Pathophysiology of Complicated Urinary Tract Infection (UTI)"