How can you tell the difference between UTI and prostatitis?

Determining whether symptoms are caused by a urinary tract infection (UTI) or prostatitis can be challenging, as there is some overlap between the signs and symptoms of these two conditions. However, there are some key differences that can help distinguish a UTI from prostatitis.

What is a UTI?

A UTI is an infection in any part of the urinary system, including the kidneys, ureters, bladder or urethra. Most UTIs involve the lower urinary tract, specifically the bladder and urethra (urethritis).

UTIs are extremely common, particularly in women. It’s estimated that 40-60% of women will develop a UTI in their lifetime. They are much less common in men, with only around 12% of men experiencing a UTI during their lifetime.

UTIs are usually caused by bacteria, most often E. coli from the gastrointestinal tract that spreads to the urethra and travels upwards into the bladder. Sexual intercourse is a common cause of UTIs in women, as bacteria can get pushed into the urethra. UTIs may also be caused by catheter use.

Symptoms of a lower UTI/bladder infection include:

  • Burning sensation when urinating
  • Frequency and urgency of urination
  • Cloudy, bloody or foul-smelling urine
  • Pelvic pain or abdominal pain
  • Low grade fever

Symptoms of an upper UTI/kidney infection include:

  • Fever and chills
  • Nausea and vomiting
  • Back, side or groin pain
  • Confusion or other mental changes (in elderly patients)

What is prostatitis?

Prostatitis refers to inflammation of the prostate gland. It affects around 10% of men at some point during their lifetime.

There are several types of prostatitis:

  • Acute bacterial prostatitis: Caused by a bacterial infection, usually E. coli. It comes on suddenly and causes severe symptoms.
  • Chronic bacterial prostatitis: Ongoing bacterial infection with recurrent UTI symptoms.
  • Chronic prostatitis/Chronic pelvic pain syndrome (CP/CPPS): Long-lasting pelvic and urinary tract pain without evidence of bacterial infection.
  • Asymptomatic inflammatory prostatitis: Inflammation found on biopsy, but no symptoms.

Risk factors for prostatitis include:

  • Recent urinary tract infection
  • STDs
  • Recent medical procedure on the urinary tract
  • Stress and anxiety
  • Previous episode of prostatitis

Symptoms of prostatitis include:

  • Pelvic pain or discomfort
  • Pain or burning during urination
  • Urgent and frequent need to urinate
  • Pain during or after ejaculation
  • Groin, lower back or abdominal pain
  • Blood in semen or urine
  • Flu-like symptoms

Key Differences Between UTI and Prostatitis Symptoms

While UTIs and prostatitis have some overlapping symptoms, there are some key differences:

Pain Location

With a UTI, pain and discomfort is typically centered around the bladder and urethra. It is felt in the lower abdomen, above the pubic bone. With prostatitis, pain is often concentrated around the prostate, rectum or perineum.


A UTI often causes cloudy, foul-smelling or bloody urine. Prostatitis may cause discharge from the penis and blood in the semen or urine.


A low-grade fever is common with a UTI. Prostatitis more often causes flu-like symptoms like chills, body aches and a high fever.

Urgency and Frequency

Both conditions cause an urgent need to urinate and frequent urination. But with a UTI, the urge tends to come on suddenly and intensely. Prostatitis causes more steady, gradual urges.

Sexual Symptoms

Prostatitis commonly causes sexual difficulties like pain during or after ejaculation and erectile dysfunction. UTIs do not directly cause sexual symptoms.

Pelvic Pain

While UTIs can cause pelvic discomfort, significant pelvic pain is more characteristic of prostatitis.

Diagnosing UTI vs Prostatitis

To diagnose the cause of urinary symptoms and distinguish between a UTI and prostatitis, the doctor will typically begin with a review of medical history and symptoms. Important questions include:

  • What symptoms are present?
  • Where is the pain located?
  • Is there any discharge or bleeding?
  • Any recent sexual activity or urinary procedures?
  • Past urinary tract infections?
  • Other medical conditions?

A physical exam will also be done to assess the abdomen, bladder, urethra, rectum and prostate. The doctor will look for any tenderness, swelling, fluid in the scrotum and other abnormalities.

Urine and blood tests are also very helpful for diagnosis. These may include:

  • Urinalysis: Checks for signs of infection like bacteria, blood and white blood cells
  • Urine culture: Identifies the bacteria causing a UTI
  • Prostate-specific antigen (PSA) blood test: Elevated PSA may indicate prostatitis
  • Complete blood count (CBC): Checks for elevated white blood cell count with infection
  • Urine cytology: Screens for cancerous cells
  • Uroflowmetry: Measures urine flow and volume
  • Imaging: An ultrasound, CT or MRI scan visualizes the urinary tract

In complicated cases, additional testing may include:

  • Cystoscopy: A small camera is inserted in the urethra to view the bladder
  • Urodynamics: Assesses bladder function and capacity
  • Prostatic massage: Fluid is expelled from the prostate and analyzed
  • Four-glass test: Urine samples are collected before and after prostate massage

A digital rectal exam is often done as well, both for diagnosis and to help relieve symptoms by draining prostate fluid.

Treating UTI vs Prostatitis

Treatment options differ for UTIs and prostatitis:

UTI Treatment

Uncomplicated UTIs are usually treated with a short course (3-7 days) of antibiotics. Commonly prescribed antibiotics for UTIs include:

  • Trimethoprim/sulfamethoxazole
  • Ciprofloxacin
  • Levofloxacin
  • Nitrofurantoin

More severe kidney infections or recurrent UTIs may require longer treatment, up to 2 weeks. IV antibiotics may be given initially if infection has spread to the kidneys.

For symptom relief, phenazopyridine or NSAIDs can help with UTI pain and discomfort. Drinking plenty of fluids and urinating frequently also help flush bacteria from the urinary tract.

Prostatitis Treatment

Treatment depends on the type of prostatitis:

  • Acute bacterial prostatitis: Oral antibiotics for 4-6 weeks, often a fluoroquinolone like ciprofloxacin or levofloxacin. May require initial IV antibiotics.
  • Chronic bacterial prostatitis: Low-dose antibiotics taken continuously for 2-4 weeks, followed by long-term antibiotics at the lowest effective dose.
  • Chronic prostatitis/CPPS: Antibiotics for 4-6 weeks to treat possible infection. Pain medications like NSAIDs. Stress management and physical therapy may help.
  • Asymptomatic inflammatory prostatitis: Usually no treatment needed, but PSA levels should be monitored for changes.

Prostatic massage, heat therapy, muscle relaxants and alpha blockers may provide additional symptomatic relief in chronic prostatitis. Lifestyle changes like stress reduction, exercise, pelvic floor stretches and avoidance of spicy foods, alcohol, and irritants like bike seats can also help.

Preventing UTI and Prostatitis

Some tips to help prevent both UTIs and prostatitis:

  • Urinate before and after sexual activity
  • Wipe front to back after using the toilet
  • Avoid holding urine for long periods
  • Stay hydrated and drink plenty of fluids
  • Avoid prolonged use of catheters when possible
  • Take showers instead of baths
  • Avoid irritating feminine hygiene sprays/wipes
  • Wear loose, cotton underwear and avoid thongs
  • Take probiotics to support urinary and prostate health

When to See a Doctor

It’s important to see a doctor promptly for symptoms like:

  • Fever over 101 F
  • Back/flank pain
  • Nausea/vomiting
  • Blood in urine
  • Inability to urinate
  • Pelvic pain that interferes with daily activities

Seeking prompt treatment can help prevent complications like kidney infection and sepsis in UTIs. Treating prostatitis right away helps reduce the risk of recurrence and chronic pelvic pain.

In elderly men, always seek medical care for new urinary symptoms, as prostatitis symptoms can mimic those of prostate cancer.

When to See a Urologist

It’s advisable to see a urologist for:

  • Recurrent UTIs (2 or more per year)
  • Symptoms lasting more than 7 days without improvement
  • Suspected prostatitis
  • Abnormal urinalysis or urine culture results
  • Other urinary tract abnormalities noted on exam or imaging
  • Pelvic pain that doesn’t improve with treatment
  • Hematuria (blood in urine) of unknown cause

A urologist specializes in treating urinary tract conditions in both men and women. They can perform specialized diagnostic tests and provide treatment options to manage chronic UTIs and prostatitis.


Distinguishing between a UTI and prostatitis can be tricky due to some overlapping symptoms like pelvic pain and urinary urgency and frequency. However, details about the location of pain, discharge, sexual symptoms, fever and testing results can help differentiate between these two conditions.

While antibiotics are front line treatment for both UTIs and prostatitis, the length of treatment and specific drugs used differ. Identifying whether the prostate or urinary tract is the source of infection is key to getting appropriate treatment.

Paying attention to symptoms and seeing a doctor promptly can help gain relief from discomfort and prevent potential complications. In recurrent or complex cases, seeing a urologist is advisable to fully evaluate the urinary tract and prostate.

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