What is the role of lab testing in the diagnosis of urinary tract infection (UTI) in males?

Updated: Aug 27, 2019
  • Author: John L Brusch, MD, FACP; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

The workup of male UTI depends on the suspected diagnosis.

Routine laboratory studies include urine studies, such as urinalysis, Gram staining, and urine culture. The threshold for establishing true UTI includes finding 2-5 or more white blood cells (WBCs) or 15 bacteria per high-power field (HPF) in a centrifuged urine sediment. In patients with systemic signs such as significant fever, chills, and/or back pain, blood cultures should be drawn. Blood cultures should also be obtained in the setting of S aureus UTI, since this may represent the sustained bacteremia of endocarditis. [1, 2]

Note that a positive nitrite test is poorly sensitive but highly specific for UTI; false-positives are uncommon. Proteinuria is commonly observed in UTIs, but it is usually low grade. More than 2g of protein per 24 hours suggests glomerular disease.


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