Male UTI Treatment And Testing

Due to the possible role of the prostate in recurrent UTI in men, approaches to male UTI treatment can vary. To determine the most appropriate treatment approach, testing is key. 

Because of the proximity of the prostate to the urinary tract, the testing methods used for males with urinary symptoms can differ from those used for UTI in females. Additional testing methods can help to pinpoint the location of an infection in males. By doing so, infection can be treated as effectively as possible. 

Read on to learn about the different testing methods used for males experiencing recurrent UTI symptoms. These include testing for infection of the prostate. We’ll also outline evidence for using different male UTI treatment methods.

Jump To Section:

• Testing For Recurrent UTI In Men >>>>
• Antibiotic Treatment For Male UTI >>>>
• Antibiotic Treatment For Chronic Bacterial Prostatitis (CBP) >>>>
• New Treatment Avenues For Recurrent UTI Symptoms In Men >>>>
• Alternative Male UTI Treatment And Prevention Strategies >>>>

You may be aware of some of the most commonly used testing methods for UTI. The most common are urine culture (when a sample is sent to a lab for testing), and rapid dipstick tests (done on the spot by you or your doctor).

For males, urine culture or enhanced tests are recommended, as UTI in males is usually considered ‘complicated’ unless proven otherwise. This is partly because UTIs in males are more unusual than UTIs in females. Also, other testing methods such as dipstick testing are less sensitive.

Having said that, research suggests that urine dipstick testing should not be relied on for either sex. This method is inaccurate in up to 70% of cases. 

Standard Urine Culture For Urinary Symptoms In Males

Standard urine culture (SUC) is the most likely test to be offered to males experiencing UTI symptoms before male UTI treatment is provided. You’re probably familiar with this type of test. Your urine sample is sent to a lab where infection-causing (uropathogenic) bacteria are encouraged to grow during an incubation period. 

Certain thresholds for the number of bacteria found are used to determine whether your results are positive or negative. Because UTI in males is usually considered complicated, the threshold used may be lower than that used for female patients. This may be helpful where male patients are concerned. But it is one of the issues with UTI testing for females – the threshold is too high.

Aside from the threshold used being a potential issue, culture testing is not without other flaws. For a start, it was designed based on the assumption that urine is sterile. We now know this is not the case. 

It has been established that hundreds of different species of bacteria reside in the healthy bladder. These previously ignored species contribute in unspecified ways to the overall state of urinary health.

You can learn more about additional reasons standard urine culture is inaccurate, and alternative testing methods you can try. 

The Four Glass Test For Bacterial Prostatitis And UTI

In addition to, or instead of standard urine culture, a clinician may conduct what is known as the Meares-Stamey four glass test, which isn’t as scary as it might sound!

Four samples are provided; three urine samples, and one with prostatic secretion. These four samples are cultured separately.

But why four? This helps determine the location of a possible infection, which helps to inform male UTI treatment.

The Meares-Stamey Process

SAMPLE:

No.1 – The first 10 ml of urine passed.

No.2 – Midstream urine (10ml collected after 150ml of urine has been passed).

No.3 – Obtained after prostatic massage, and contains secretions of the prostate.

No.4 – Contains the first 10 ml of urine after the prostatic massage.

If bacterial growth is found in the first sample, urethral infection is most likely. In the second, this may be a sign of bladder infection. If bacterial growth is found in the prostatic secretion or the last urine sample, the infection is more likely to be located in the prostate.

Recommendations have been made for the use of this test where infection of the prostate is a possibility.

Dr. Malde, urology specialist, also suggests that interpretation of the results from the four glass test can be considered in combination with patient-reported symptoms. For example, if bacterial growth is found in prostatic secretions, and a patient also reports scrotal pain, the likelihood of prostate infection is greater.

Alternative Tests For Recurrent UTI In Men

An additional testing method used for recurrent UTI in men, if results remain unclear, is semen testing. This may involve culture and DNA-based methods. Semen may be tested as sometimes infection-causing bacteria within the male genitourinary tract can only be detected in the urine OR only in the semen.

Some diagnostics companies provide a combined testing kit for urine and semen, such as that offered by MicroGenDX, which uses DNA-based sequencing to detect specific bacteria in the urine and semen samples. 

While this test kit can be ordered directly by the patient, and samples collected at home, it’s best to work with a clinician. They can sign off on the test and enable the prescription of male UTI treatment options if required. A clinician’s signature is required for antibiotic recommendations to be included in test results.

This test might be particularly useful if you suspect that bacteria are being sexually transferred between you and your partner. Sexual transference of bacteria could potentially be causing a recurrent problem. Maybe you want to find out more from an analysis of the bacteria in your respective samples.

If you have a female partner who is also interested in testing, MicroGenDX offers a test kit for female patients, which involves the analysis of both urine and vaginal samples. 

Learn more about at-home UTI testing options.

A medical professional will take into consideration your symptoms, and the results of whichever testing methods have been used. They will then prescribe treatment. 

Treatment for male UTI primarily involves the prescription of antibiotics. The type of antibiotic and course duration will depend on whether you are being treated for an acute (one-off) UTI or recurrent UTI.

Antibiotic Treatment For Acute UTI In Men

If your clinician treats under the assumption of an acute UTI, a 7-day course of antibiotics will typically be recommended. Antibiotic course duration has recently been reduced to 7 days for male UTI treatment and 3 days for female treatment. Researchers found that longer courses of antibiotics did not significantly improve outcomes.

Around 10% of men who are prescribed a 7-day course of antibiotics experience UTI symptom recurrence within 28 days of finishing treatment. 13% experienced recurrence who were prescribed a 14-day course. 

And for women, it has been found that approximately 29% who are prescribed a 3-day course of antibiotics will experience relapse or reinfection at 6 weeks after finishing treatment. This is compared with 31% who complete a 7-day course. Relapse was considered as infection thought to be caused by the same uropathogen, and reinfection caused by a different uropathogen.

So the research indicates that when treatment is guided by SUC results, shorter courses of antibiotics may be more appropriate for the treatment of acute UTI. The outcome is much the same, and they reduce the risk of antibiotic resistance. 

That being said, we do not know how many of the participants in these studies experienced a recurrence of their symptoms after the 28-day and 6-week follow-up periods. It is yet to be established whether tracking outcomes over a longer period of time, or using more advanced testing methods, might reveal that there is in fact a significant difference between the efficacy of shorter and longer courses of antibiotic treatment.

Antibiotic Treatment For Recurrent UTI In Men

While courses of antibiotic treatment for acute UTI in men have been shortened, the recommended antibiotic treatment for recurrent UTI is slightly different. This is due to the possibility of prostate infection (e.g. chronic bacterial prostatitis). The prostate may play a role in the recurrence of urinary symptoms, so a longer course of antibiotics might be recommended. Some suggest at least a 2 week course, while others suggest 2 to 4 weeks of treatment.

Some antibiotics like Nitrofurantoin, which are typically used to treat UTIs, are not recommended for male UTI treatment where recurrence is an issue. This is because they don’t reach sufficient tissue concentrations in the prostate. 

Fluoroquinolones are the most commonly prescribed type of antibiotic for male UTI treatment (they make up 65% of prescriptions). This family of antibiotics target two enzymes which are needed for the growth and division of harmful bacteria. A 2018 study provided evidence in favour of long-term antibiotic treatment for recurrent UTI.

NOTE: Fluoroquinolones come with a black box warning stating that this antibiotic class “should not be prescribed for patients who have other treatment options for… uncomplicated urinary tract infections (UTI) because the risks outweigh the benefits in these patients and other antibiotics to treat these conditions are available” (FDA Drug Safety and Availability).

For suspected bacterial prostatitis, the National Institute for Health and Care Excellence (NICE) recommends the following. Their recommendations are based on evidence for antibiotic ability to penetrate the prostate:

When there is concern about resistance to quinolones, other antibiotics that can reach therapeutic prostate levels include third generation cephalosporins, carbapenems, some aminoglycosides, piperacillin, minocycline, doxycycline, erythromycin, clindamycin and trimethoprim.

Where a diagnosis of chronic bacterial prostatitis is given, NICE recommends a prescription of either trimethoprim (200mg) or doxycycline (100mg) twice daily for 4 to 6 weeks.

But there is also evidence to suggest that with confirmed CBP, injection of antibiotics directly into the prostate (through the rectum or the perineum) can be more effective at treating infection than antibiotics taken orally:

• In one study, over half of men treated with injections were infection-free for at least 1 year following treatment. For a further 28% of men, the bacterial load in the prostate was at least reduced. 
• In another study, injection of antibiotics into the prostate resulted in a ‘complete cure’ (based on imaging that can detect sites of bacterial infection) for 23% of patients. This is compared to almost 17% of those who took antibiotics orally.

This being said, more research is needed to compare the long-term effects of these methods in order to clarify their efficacy. Especially as antibiotic injection may come with discomfort and additional risk. In addition, over half (57.7%) of patients in the second study experienced temporary blood in their urine and/or semen. However, no serious side effects were reported.

There are also new treatment methods being assessed for their efficacy in the treatment of chronic bacterial prostatitis and recurrent UTI in men. These include phage therapy and vaccines.

Phage Therapy

It’s been found that phage therapy may prove to be an effective alternative male UTI treatment in the future. This treatment uses bacteriophages to infect and destroy certain strains of bacteria. Phage therapy shows potential in reducing the presence of harmful bacteria and resolving infection in cases of bacterial prostatitis. Read more about phage therapy for UTI. 

UTI Vaccines

A number of UTI vaccines that target specific bacterial species have been developed. Some are still at the stage of human trials, while others may be accessed via clinicians in certain regions. A review conducted in 2020 found that a UTI vaccine in the form of a spray could be effective for both female and male UTI treatment where recurrence is an issue.

This particular spray vaccine contains whole bacterial cells (comprising equal parts of the four most commonly found UTI-causing bacteria: E. coli, K. pneumoniae, P. vulgaris and E. faecalis). The bacterial cells are inactivated and interact with the immune system, leading to greater protection against infection. 

As well as antibiotic treatment, and a couple of potential new treatment avenues, there are a number of other alternative male UTI treatment or prevention strategies available to those experiencing recurrent UTI.

Probiotics

Probiotics, or ‘good bacteria,’ are supported by a wealth of evidence for their role in supporting gut health. Research into their effectiveness in treating recurrent UTI is deemed to be of poor quality. So, it’s hard to draw conclusions. 

At present, some evidence suggests that probiotic treatment is no more effective than antibiotic treatment, including antibiotic prophylaxis.

However, in theory probiotics may be useful in the prevention of UTI for a few reasons:

1. Probiotics lodge themselves in the same locations where uropathogenic bacteria might settle. This means that there is limited space for harmful bacteria to colonize.
2. They are also involved in maintaining a low pH, which creates an environment that some harmful bacteria don’t like.
3. They produce antimicrobial substances.

Research is lacking on the use of probiotics for recurrent UTI in males. However, here is what has been found so far:

• 8% of CBP patients who used a supplement containing a probiotic (Lactobacillus sporogenes) in addition to antibiotic treatment experienced recurrence at 2 months, compared with 28% of patients using antibiotic treatment alone. Results for recurrent UTI may be similar, as the bacterial etiology of CBP and recurrent UTI in men is similar.
• Recurrences of bacterial prostatitis, and the bacterial load of E. coli and E. faecalis, were also reduced in males taking a probiotic supplement containing strains of Lactobacillus for 12 weeks, compared with males taking a placebo.

Two of the same Lactobacillus strains (Lactobacillus reuteri and Lactobacillus fermentum) have also been successful probiotics for reducing recurrent UTI in females, suggesting that similar mechanisms may be at play.

There is still research to be done on the function of probiotics for males, including comparison of the use of probiotics for UTI vs. prostate infection. However, this preliminary evidence indicates potential for probiotics reducing the recurrence of bacterial infections.

Vitamin D For UTI

Research into the use of vitamin D as a preventative measure for UTI shows that it has more potential for males with the condition than females. 

One 5-year-long study found that 44 UTIs were reported among 256 male and female patients who were taking vitamin D, compared with 97 UTI incidences in a control group of similar size who were not taking the supplement. This difference was even more pronounced for the male patients (3 out of 161 male patients taking vitamin D vs. 11 out of 153 in the male control group).

Another study found that fewer men with benign prostatic hyperplasia (BPH) developed recurrent UTI while using vitamin D than men who were not using vitamin D. The researchers discuss that vitamin D in fact lowers the risk of BPH. It does so by regulating the growth of the prostate gland. And with a decreased risk of BPH, the risk of UTI is also lowered.

Vitamin D in particular also improves immune function. This is evidenced by the presence of vitamin D receptors in immune system cells (e.g. lymphocytes). It is also known to trigger the release of antimicrobial substances, similar to probiotics.

D-mannose For Recurrent UTI In Men

D-mannose has also been tested in studies including both biological sexes. For males with recurrent UTI, D-mannose has been shown to reduce incidences of UTI and prolong UTI-free intervals, as well as improve quality of life in patients.

We know that there is a lot of information to take in when it comes to male UTI treatment  – from the different testing methods used, to antibiotic and non-antibiotic treatment and prevention approaches. For this reason, it’s important to get the right support, and find the right practitioner. This can help you in navigating your options. 

If you would like more information about specialists in your area, please reach out to us. Leave a comment below if you’d like to share your experience with others.