The Male “Urinary Tract Infection:” A Hidden Cause of Infertility

This week I want to talk about something I see pretty often in my male patients.  It’s a condition that is often an unrecognized source of problems ranging from the merely inconvenient – having to get up frequently in the middle of the night to pee – to the serious: impaired fertility.

I’m talking about a low-grade infection of the male urinary tract, specifically the prostate (otherwise known as chronic prostatitis.) This is different from acute prostatitis, which is usually caused by a relatively fast-developing bacterial infection. The signs of acute prostatitis are usually severe:

ChillsFeverIncreased frequency of urinationIntense burning during urinationInability to empty the bladder

Acute prostatitis should be treated immediately because the scarring that can develop from the infection can block the ejaculatory ducts, which are the tiny “ports” that allow sperm to mix with semen during ejaculation.

But here’s the thing: a lot of guys have mild, chronic infections that produce only subtle symptoms, such as occasional urinary frequency, mild but chronic fatigue, a dull aching in the lower back, testicles or bladder region, or no symptoms at all. A recent study of guys who did not complain of urinary symptoms, found that 32% showed evidence of low-grade infection or prostatitis. That’s a pretty staggering figure – and it’s got some important implications. For one thing, we know that prostatitis can raise the level of prostate-specific antigen (PSA) in the blood. PSA is what doctors measure as an indication of prostate health and, specifically, prostate cancer. If a third of men have unrecognized chronic prostatitis, this means their PSA levels may be higher than normal and they may be shunted into additional tests for prostate cancer when the real problem is a low-grade infection or inflammation that could be easily cleared up with antibiotics or anti-inflammatory medication.

In addition, the low-grade infections may be hurting the men’s fertility. This is why one of the first things I look for if there’s a question about a guy’s fertility is low-grade prostatitis. Many doctors test for prostatitis by testing a sample of urine. I don’t do that.

Why? Because urine is a fairly dilute liquid, which makes it harder to detect low levels of bacteria or other causes of infection. A better approach is to culture a semen sample. Semen is much more concentrated so testing it is a more sensitive way to detect infection-causing agents. 

The good news is that prostatitis is relatively easy to clear up – though you have to be careful. You’ll need to take the medicine for at least 2 weeks, and possibly for as long as 4-12 weeks. It is very important that you continue to take the antibiotics as directed by your doctor, even if you don’t feel any symptoms!  Bacteria in the prostate can be difficult to kill. If even a few remain alive, they can grow and either your symptoms will return or, worse, you’ll feel OK even though your fertility may be impaired. Overall, prostatitis is often overlooked, but when present can easily be treated resulting in improved fertility and ultimately…a healthy baby!