Men get urinary tract infections when bacteria enter the urethra and travel up into the bladder, prostate, or kidneys. While UTIs are far more common in women, they’re not rare in men, especially with age. About 0.9% of men ages 18 to 24 get a UTI in a given year, but that number climbs steadily, reaching 7.7% in men 85 and older. Half of all UTIs diagnosed in men occur in those over 65.
How Bacteria Enter the Male Urinary Tract
The most common route is straightforward: intestinal bacteria, particularly E. coli, spread from the skin around the anus to the opening of the urethra and travel upward into the bladder. E. coli causes roughly 25% of male UTIs, with other gut bacteria like Proteus and Klebsiella responsible for much of the rest. These bacteria have specialized structures on their surface that let them latch onto the lining of the urinary tract, which is how they establish an infection rather than simply getting flushed out with urine.
Men have a built-in advantage here: a longer urethra means bacteria have a greater distance to travel before reaching the bladder. That’s the main reason UTIs are less common in men than women. But “less common” doesn’t mean impossible, and several factors can overcome that anatomical protection.
Sexual Activity and Bacterial Transfer
Sex is one of the more common ways younger men develop UTIs. During intercourse, bacteria can be pushed toward or into the urethral opening. Anal intercourse carries a higher risk because it introduces E. coli and other intestinal bacteria directly. Being uncircumcised also increases risk, likely because bacteria can colonize the area beneath the foreskin more easily.
Sexually transmitted infections are a separate but related concern. Gonorrhea and chlamydia can cause urethritis, an infection of the urethra itself, which produces symptoms that overlap with a traditional UTI: burning during urination, discharge, and urgency.
The Prostate Connection
The prostate gland sits just below the bladder, and the urethra runs directly through it. This positioning makes the prostate both a contributor to UTIs and a target for infection.
As men age, the prostate commonly enlarges, a condition known as benign prostatic hyperplasia (BPH). A bigger prostate squeezes the urethra and makes it harder to fully empty the bladder. Urine that sits in the bladder becomes a breeding ground for bacteria. Over time, incomplete emptying can also stretch and weaken the bladder wall, making it even less effective at pushing urine out. This creates a cycle where the risk of infection keeps increasing.
Bacteria can also travel from the urethra or bladder backward through the prostatic ducts and infect the prostate itself, a condition called prostatitis. This distinction matters because prostatitis can cause symptoms that look like a standard UTI, including urinary frequency, urgency, weak stream, and straining to urinate, but also produces pelvic pain, testicular pain, and flank pain. Standard urine cultures sometimes miss prostatitis entirely. Some urologists will culture prostatic fluid or a semen sample to identify the specific bacteria involved, which can lead to more targeted treatment.
Other Risk Factors
Several medical conditions raise a man’s chances of developing a UTI:
- Diabetes: People with diabetes face up to 10 times the risk of UTIs. The body produces natural antimicrobial proteins that protect the urinary tract, and researchers have found that these proteins are significantly reduced in people with diabetes. Insulin helps regulate their production, which is part of why well-managed blood sugar matters for more than just glucose control.
- Kidney stones: Stones can obstruct urine flow at various points in the urinary tract, creating the same stagnant-urine problem that an enlarged prostate causes.
- Catheter use: Any tube placed in the urethra gives bacteria a direct path into the bladder, bypassing the body’s normal defenses.
- Weakened immune system: Conditions or medications that suppress immune function make it harder for the body to fight off bacteria that enter the urinary tract.
What a Male UTI Feels Like
Lower tract infections (bladder and urethra) typically cause a burning sensation during urination, a frequent urge to urinate even when little comes out, cloudy or strong-smelling urine, and sometimes blood in the urine. Upper tract infections, where bacteria have reached the kidneys, tend to produce fever, chills, nausea, and pain in the back or side. These symptoms warrant prompt attention because kidney infections can progress to a bloodstream infection if left untreated.
How Treatment Differs for Men
Women with a simple bladder infection often receive a short antibiotic course of just three days. Men typically need longer treatment. Current guidelines recommend 5 to 7 days for a straightforward complicated UTI, and 7 days if a different class of antibiotic is used. When prostatitis is suspected, treatment often extends to 10 to 14 days or longer, sometimes up to 4 to 6 weeks for chronic cases. The prostate is difficult for antibiotics to penetrate, which is why infections there take more time to clear.
Because UTIs in men often signal an underlying issue like an enlarged prostate, a blockage, or a structural abnormality, doctors will sometimes order imaging or further testing after the infection clears, particularly in younger men where UTIs are unusual or in anyone with recurrent infections.
Lowering Your Risk
Several practical habits can reduce the likelihood of infection. Urinating at least every three to four hours prevents urine from sitting in the bladder long enough for bacteria to multiply. When you do urinate, take enough time to empty your bladder completely rather than rushing. Urinating shortly after sex helps flush out any bacteria that may have been introduced during intercourse.
Staying well hydrated keeps urine dilute and flowing regularly. Wearing cotton underwear and loose-fitting pants helps keep the area around the urethra dry, since moisture promotes bacterial growth. Pelvic floor exercises can also help by strengthening the muscles involved in fully emptying the bladder, which is especially relevant for older men dealing with an enlarged prostate.