URINARY-TRACT INFECTION IN MEN, INCLUDING PROSTATITIS, EPIDIDYMITIS, NONSPECIFIC URETHRITIS AND REITERS-SYNDROME

Bacteriuria is more common in females than males except in the first y ear of life. There is an association between circumcision status and t he risk of febrile urinary tract infection (UTI) in male infants. Most UTls in men are complicated and relate to a combination of two factor s: disturbed urodynamics and invasive ability of uropathogens. A signi ficant number of men experience UTI in association with bacterial inva sion of the prostate, the seminal vesicles and the epididymis (male ad nexitis). In these men, to eradicate bacteriuria antibacterial agents with adequate pharmacokinetic properties have to be used for a suffici ent length of time. Non-specific urethritis, including non-gonococcal and postgonococcal urethritis, in about 50% of cases is caused by Chla mydia trachomatis and in about 5-10% of cases, by other agents such as Ureaplasma urealyticum and Trichomonas vaginalis. Examining the first -voided urine from men is as sensitive as testing a urethral swab for C. trachomatis. For chlamydial genital infections, tetracyclines, fluo roquinolones, erythromycin and the newer macrolides are suitable drugs . Azithromycin, prescribed as single-dose therapy is equivalent to 7-d ay course. Approximately 1% of men presenting with non-specific urethr itis develop sexually-acquired reactive arthritis, one-third of these acquiring Reiter's syndrome. Studies have identified chlamydial elemen tary bodies in joint material in some of these patients. Placebo-contr olled treatment studies have demonstrated diminished duration of activ e arthritis in the treatment group.