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, and a real possibility that the prostate is involved.
The practical consequences are threefold: 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 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
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