GPAtlas🧭 When to suspect
A lower urinary tract infection (UTI) in a man is an infection of the bladder (cystitis) or urethra, presenting with dysuria, frequency, urgency, and sometimes visible haematuria or suprapubic discomfort.
Unlike in women, every UTI in a man is regarded as complicated:
• There is a higher background rate of structural or functional abnormality.
• There is a real possibility that the prostate is involved.
So send a culture in every case, treat for longer (7 days, not 3), and ask what lies behind the infection.
Two diagnoses must always sit alongside simple cystitis – acute prostatitis (which changes the antibiotic choice and duration) and acute pyelonephritis (an upper UTI needing different management).
In a sexually active man, urethritis from a sexually transmitted infection can closely mimic a UTI.
| Pattern | Suggestive features |
|---|---|
| Lower UTI (cystitis) | • Dysuria, frequency, urgency, suprapubic discomfort, possible visible haematuria • Systemically well |
| Acute prostatitis | • The above plus fever/rigors, perineal, low-back or pelvic pain, painful ejaculation, voiding difficulty • Tender, boggy prostate on gentle digital rectal examination (DRE) |
| Acute pyelonephritis (upper UTI) | • Loin/flank pain, fever > 38°C, rigors, nausea or vomiting, systemic upset • Costovertebral angle tenderness |
| Urethritis/STI | • Urethral discharge, dysuria, recent new sexual partner • Consider chlamydia/gonorrhoea – tested and treated differently |
Source: NICE NG109 · NICE NG110
🔒 Sign up free to read the full topic
You're viewing a free preview. Create a free account to unlock the rest.
Sign up free →Sample topics are open to everyone in the Free Sample Bundle.