UTIs in Men: Why They're Different, Why They Matter
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A urinary tract infection (UTI) is an infection anywhere along the urinary tract — the urethra, bladder, ureters, or kidneys. Women get them more often because of anatomy (a shorter urethra sits closer to bacteria). Men get them less often. But when a man gets one, the clinical bar for investigation is higher.
Most guidelines, including Therapeutic Guidelines and the Urological Society of Australia and New Zealand, treat a male UTI as a complicated UTI by default. That’s not a throwaway label. It means the infection is more likely to involve something structural — the prostate, an enlarged bladder outlet, an incomplete empty, kidney stones, a stricture — and more likely to need follow-up beyond a simple antibiotic course.
“Men just don’t get UTIs” is a myth that delays care. They do. And when they do, it’s worth taking seriously.
The symptoms overlap with what women describe, but men sometimes notice them differently or brush them off for longer. Common signs include:
- Burning or pain on urinating — the most classic symptom
- Needing to urinate more often or urgently, even when little comes out
- Cloudy, dark, or strong-smelling urine
- Blood in the urine — visible or picked up on a dipstick
- Pain in the lower abdomen or pelvis
- Pain or pressure around the testicles, perineum, or rectum — more likely if the prostate is involved
- A feeling that the bladder isn’t emptying properly
Red flags that need urgent attention:
- Fever, chills, or shaking — signs the infection has moved upward, usually to the kidneys or prostate
- Flank pain — a dull, aching pain on one side of the lower back
- Nausea, vomiting, confusion, or feeling unwell beyond the urinary symptoms
- Inability to urinate — this is an emergency (acute urinary retention)
- Recurring episodes — three or more UTIs in a year, or two within six months
Any of the above warrants same-day in-person medical attention. An uncomplicated, mild UTI without these features can usually start with a telehealth consult for assessment.
Three main pathways explain most male UTIs.
1. Something’s blocking full drainage. The most common underlying reason in men over 50 is an enlarged prostate (benign prostatic hyperplasia, or BPH). When the bladder can’t empty fully, residual urine creates a culture medium for bacteria. Kidney stones, urethral strictures, and bladder outlet obstruction do the same thing.
2. The prostate itself is infected. Prostatitis — inflammation or infection of the prostate — presents a lot like a UTI but with extra pelvic or perineal pain. Acute bacterial prostatitis is painful and needs prompt treatment. Chronic forms can be tricky to diagnose.
3. Instrumentation, catheters, or recent urological procedures. Anything that’s been up the urethra recently (a catheter, a cystoscopy) raises UTI risk. So do indwelling catheters in men with long-term continence issues.
Less common but important: diabetes that’s not well controlled, immune suppression, structural anomalies, and in some cases, sexually transmitted infections that present with UTI-like symptoms.
In younger men with no obstruction, no instrumentation, and no immune concerns, a true UTI is unusual. That’s actually why it matters — it means there’s often a “why” worth finding.
A practitioner will usually want three things before treating:
- A careful history. Symptoms, timing, previous episodes, sexual history, medications, recent procedures, prostate symptoms, general health.
- A urine sample. Dipstick in-clinic, and — important in men — a formal mid-stream urine (MSU) culture sent to pathology. The culture identifies the bacteria and tests which antibiotics will work, which matters more in men because the bacterial profile is more varied.
- An examination in some cases. A prostate exam may be needed if prostatitis is suspected. A scrotal exam may be needed if testicular involvement is suspected. Neither is optional if the symptoms point that way.
Telehealth can handle the history and initiate investigations (send the patient for an MSU). For men, telehealth should almost always be the first step, not the only step — especially when red flags, prostate involvement, or recurrent infections are on the table.
Treatment depends on what the culture shows and how severe the infection is. Because male UTIs are classed as complicated, the treatment course is usually longer than for a straightforward female UTI — often 7 to 14 days rather than 3 to 5 — and the antibiotic is chosen based on the culture result, not guesswork.
We don’t name specific medications here on purpose. Antibiotic choice depends on the bacteria, local resistance patterns, your kidney function, your other medications, and clinical judgement. That’s a decision for your GP and pharmacist, informed by pathology. Self-diagnosing or re-using leftover antibiotics can mask a more serious infection and contribute to resistance.
Beyond antibiotics, treatment sometimes means:
- Investigating the underlying cause — an ultrasound for residual bladder volume, a prostate assessment, referral to a urologist if obstruction is suspected
- Treating prostatitis differently — antibiotic courses for bacterial prostatitis can run 4 to 6 weeks, and require monitoring
- Drinking water and pain relief — basic supportive care, alongside medical treatment, not instead of it
If symptoms don’t improve within 48 to 72 hours of starting treatment — or if they get worse — that’s a reason to go back to the practitioner, not to wait it out.
Recurring UTIs?
If you’ve never had one before and you’re noticing burning on urination or going more often than normal, book a consult. For men, even a first episode is worth assessing properly.
Book a consult if:
- You have burning, urgency, or frequency lasting more than 24–48 hours
- You see blood in your urine
- You have pelvic, testicular, or perineal pain
- You’re over 50 and having urinary changes you haven’t had before
- You’ve had a UTI in the past and feel one starting again
Go to an emergency department — or call an ambulance — if:
- You have a fever, chills, or feel genuinely unwell
- You have one-sided back pain with urinary symptoms
- You can’t urinate at all
- You’re vomiting, confused, or your symptoms are escalating rapidly
These are signs the infection may have reached the kidneys or become systemic. They need in-person care, imaging, and sometimes IV treatment.
Abby Health is an online-first Australian clinic. Our GPs are AHPRA-registered. When you book a consult, Abby AI, our medical AI, prepares a clinical brief for your doctor — your history, medications, any previous urinary symptoms — so they’re not asking you to start from scratch.
For men with suspected UTI symptoms, your Abby GP will take a thorough history, arrange pathology if appropriate (you’ll get a referral to get an MSU done locally), and decide on next steps based on the result. If they think you need an in-person examination, imaging, or specialist review, they’ll tell you directly and help you work out how to access it.
We don’t pretend telehealth can do everything. For male UTIs, it’s often the right first step — and sometimes the first step to a longer investigation that ends with good, continuous care rather than another round of “try this and see.”
For more on how telehealth prescribing works in Australia, see how telehealth prescriptions work in Australia. If you’re specifically looking for a repeat prescription for an ongoing condition, see how to refill a prescription online in Australia.
Abby Health consultations are bulk billed for eligible patients with a valid Medicare card.
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