Male Genital Infections

What counts as a male genital infection

The male genital tract includes the urethra (the tube that carries urine and semen), the penis and foreskin, the scrotum and its skin, the testicles, the epididymis (the coiled tube behind each testicle) and the prostate gland. Infection can start at any of these sites and can spread along the tract. In younger, sexually active men, sexually transmitted bacteria cause most infections. In older men, and in men who have had a catheter or prostate procedure, bacteria from the urinary tract are more often to blame.

Types of bacterial infection of the male genitalia

Urethritis

Urethritis is inflammation of the urethra. It causes a white, yellow or green discharge from the tip of the penis and burning or stinging when peeing. The main causes are chlamydia, gonorrhea, Mycoplasma genitalium and trichomonas. Gonorrhea usually causes a heavier, pus-like discharge within days of exposure. Chlamydia often causes mild symptoms or none at all.

Epididymitis and orchitis

Epididymitis is infection of the epididymis. Pain and swelling build over a day or two at the back of one testicle and may spread to the whole testicle (epididymo-orchitis). There may be fever, redness of the scrotum and urethral discharge. Under age 35, chlamydia and gonorrhea are the usual causes. Over 35, E. coli and other urinary bacteria are more likely. Orchitis without epididymitis is often viral, especially from mumps.

Balanitis and balanoposthitis

Balanitis is inflammation of the head of the penis. When the foreskin is involved too, it is called balanoposthitis. It causes redness, soreness, itching, a shiny or blotchy rash, and sometimes a smelly discharge under the foreskin. It is most common in uncircumcised men. Candida yeast is the most frequent infectious cause, especially in men with diabetes. Bacteria such as streptococci can also cause it, and irritation from soaps can mimic infection.

Prostatitis

Acute bacterial prostatitis is a sudden infection of the prostate. It causes fever, chills, pain between the scrotum and anus, burning urination and difficulty passing urine. It needs prompt antibiotics and sometimes hospital care. Chronic bacterial prostatitis causes repeated urinary infections with the same bacteria.

Skin infections of the genitals

• Cellulitis: spreading redness and warmth of the skin of the penis or scrotum.
• Folliculitis and boils: infected hair follicles, often after shaving.
• Fournier gangrene: a rare, life-threatening infection that rapidly destroys the tissue of the genitals and perineum. Diabetes, obesity and heavy alcohol use raise the risk. It needs emergency surgery.

Sexually transmitted infections with sores

• Syphilis: a painless, firm ulcer (chancre) at the site of infection, 10 to 90 days after exposure.
• Chancroid and lymphogranuloma venereum: rarer bacterial STIs that cause painful ulcers or swollen groin glands.

Genital herpes (a virus), genital warts (HPV) and jock itch (a fungus) are common non-bacterial causes of genital symptoms and are often confused with bacterial infection.

Symptoms at a glance

Risk factors

• unprotected sex and new or multiple partners
• a past STI
• being uncircumcised, especially with poor hygiene or a tight foreskin (phimosis)
• diabetes
• a urinary catheter, recent prostate biopsy or urinary tract procedure
• an enlarged prostate or other cause of urine retention

Diagnosis

A doctor will ask about symptoms, sexual partners and condom use, and examine the penis, scrotum and groin. A rectal exam may be done to check the prostate. Testing usually includes:

• a first-catch urine sample tested by nucleic acid amplification (NAAT) for chlamydia and gonorrhea, and often Mycoplasma genitalium
• a swab of any discharge or sore
• urine culture for urinary bacteria, especially in older men
• blood tests for syphilis and HIV
• scrotal ultrasound if torsion, an abscess or a tumor needs to be ruled out

Treatment

• STIs: antibiotics chosen according to the organism and current CDC guidance. For gonorrhea this is usually an injection. Avoid sex until you and your partners have finished treatment and symptoms have resolved, usually 7 days.
• Epididymitis: antibiotics, plus rest, scrotal support, ice packs and pain relief.
• Balanitis: gentle daily washing with water, avoiding soap, and an antifungal or antibiotic cream depending on the cause. Check blood sugar if it keeps returning.
• Prostatitis: a longer course of antibiotics, often several weeks.
• Fournier gangrene: emergency surgery and intravenous antibiotics.

Partners from the past 60 days should be tested and treated when an STI is found, even if they have no symptoms. Retest for chlamydia and gonorrhea about 3 months after treatment, because reinfection is common.

Complications

Untreated infections can cause an abscess in the scrotum or prostate, chronic testicular pain, scarring of the urethra (stricture), reduced fertility, and, with STIs, spread to partners and a higher risk of acquiring HIV. Reactive arthritis can follow chlamydia.

Prevention

• Use condoms consistently, and limit the number of partners.
• Get regular STI screening if you have new partners.
• Keep the area under the foreskin clean and dry.
• Keep diabetes well controlled.
• Get vaccinated against HPV and hepatitis B, and against mumps with MMR.

Frequently asked questions

What are the signs of a bacterial infection of the male genitalia?

Common signs are discharge from the penis, burning when peeing, redness or soreness of the head of the penis, a painful or swollen testicle, an ulcer, and fever. Some infections, especially chlamydia, often cause no symptoms, so testing is the only way to know.

Can you get a genital infection without having sex?

Yes. Balanitis from yeast or skin bacteria, epididymitis from urinary bacteria, prostatitis and cellulitis can all happen without sexual contact. They are more common with diabetes, an uncircumcised penis, a catheter or an enlarged prostate.

How long does it take antibiotics to clear a genital infection?

Discharge and burning from urethritis usually improve within a few days of treatment. Epididymitis pain eases within days, but swelling can take weeks to settle. Prostatitis needs several weeks of antibiotics. See a doctor again if you are not improving within 3 days.

Is a swollen testicle always an infection?

No. A sudden, severe pain in one testicle, especially in a younger male, may be testicular torsion, a twisted cord that cuts off blood supply. This needs surgery within hours. Painless swelling or a lump can be a cyst, hydrocele or, rarely, a tumor.

Should my partner be treated too?

If you have an STI such as chlamydia, gonorrhea or trichomonas, yes. Partners from the last 60 days need testing and treatment, even without symptoms, or the infection will pass back to you. Yeast balanitis in a man may come from a partner's vaginal yeast infection.