How is urinary tract infection (UTI) differentiated from urethritis in males?

Updated: Jan 02, 2020
  • Author: John L Brusch, MD, FACP; Chief Editor: Michael Stuart Bronze, MD  more...
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One of the difficulties in diagnosing urinary tract infections (UTIs) in males lies in the fact that dysuria, with or without discharge, is the typical chief complaint with urethritis, which is a much more common disease. Determining the history of urinary and genital tract symptoms and sexual encounters, combined with laboratory testing of urine and urethral swabs, should allow differentiation of the 2 conditions. Absence of bacteruria despite symptoms of frequency, urgency, or dysuria suggests urethritis. However, bacteruria may be symptomatic or asymptomatic.

In males aged 15-50 years, UTI is more common in males with anatomic abnormalities; in the sexually active male with no urinary tract abnormalities, sexually transmitted disease (STD) – related urethritis predominates, although UTI may occasionally be diagnosed.

In elderly patients, the typical manifestations of UTI may be absent or replaced by vague findings of failure to thrive or worsening mental status. In addition, failure to consider an obstructing urinary calculus in this patient population results in delay of inpatient consultation with a urologist in the septic elderly patient.

Patients with diabetes and those with recent urinary tract instrumentation, recent hospitalization, or taking broad-spectrum antibiotics have an increased incidence of resistant organisms.

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