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From the Family Practice Inquiries Network

SGLT-2 Inhibitors and Increased Risk of Urogenital Infections

Julia Swanson, MD
Kathleen Lucier, DO
Maikha Jean-Baptiste, MD
Jon O. Neher, MD

American Family Physician. 2026;113(3):281-282.

Author disclosure: No relevant financial relationships.

This clinical content conforms to AAFP criteria for CME.

CLINICAL QUESTION

Do sodium-glucose cotransporter-2 (SGLT-2) inhibitors increase the risk of urogenital infections?

EVIDENCE-BASED ANSWER

Physicians should counsel adults treated with SGLT-2 inhibitors about an increased risk of urogenital infections. (Strength of Recommendation: A, meta-analysis of randomized controlled trials [RCTs].) Groups at highest risk include women, patients with obesity, and patients treated for 6 months or longer. There is also a small increase in the risk of urinary tract infection (UTI) in patients treated with SGLT-2 inhibitors. These medications do not appear to increase the risk of Fournier gangrene.

EVIDENCE SUMMARY

Urogenital Infections

A 2024 network meta-analysis evaluated the risk of urogenital infections in adults and compared SGLT-2 inhibitors with placebo or standard care. Of the 264 included studies, 62% specifically enrolled patients with type 2 diabetes. All but two studies included male and female patients. Patient mean ages ranged from 22 to 81 years.1

The meta-analysis showed an increased risk of genital infections with SGLT-2 inhibitor treatment compared with placebo or standard care (188 trials; n = 121,275; odds ratio [OR] = 3.5; 95% CI, 3.1–3.9). Number needed to harm values across studies ranged between 16 and 31. There was a significantly lower risk of treatment-associated infections in male vs female patients (69 trials; n = 63,248; OR = 0.4; 95% CI, 0.4–0.5). In meta-regression analysis, a body mass index of 30 kg/m2 or greater (compared with a body mass index less than 25 kg/m2; OR = 3.3; 95% CI, 1.1–10.3) and use of SGLT-2 inhibitor therapy for 6 months or longer (compared with less than 6 months; OR = 1.7; 95% CI, 1.3–2.3) appeared to increase the risk of treatment-related genital infection.1

A 2023 systematic review and meta-analysis evaluated the effect of SGLT-2 inhibitors on the risk of urogenital infections in patients without diabetes. The authors identified nine RCTs (n = 7,326) that included patients receiving SGLT-2 inhibitors compared with placebo (there was no overlap with the previously discussed 2024 meta-analysis). Four of the RCTs (n = 7,317) evaluated outcomes in patients with or without diabetes. All nine studies enrolled male and female adults with no age restrictions.2

In patients without diabetes, SGLT-2 inhibitors increased the odds of genital infections compared with placebo (OR = 3.01; 95% CI, 1.93–4.68; P < .0001). In patients with diabetes, SGLT-2 inhibitor use was more likely to increase the odds of genital infections than in patients without diabetes (OR = 1.36; 95% CI, 1.07–1.72; P < .0001). The odds of developing genital infections were similar in placebo-treated patients with and without diabetes (OR = 1.14; 95% CI, 0.36–3.66; P = .35).2

Urinary Tract Infections

The 2024 network meta-analysis discussed initially also identified 213 studies (n = 150,140) that assessed whether SGLT-2 inhibitors increased the risk of UTI. Trials compared various SGLT-2 inhibitors with placebo, standard care, and other SGLT-2 inhibitors. The meta-analysis found an increased risk of UTI with SGLT-2 inhibitor therapy (OR = 1.11; 95% CI, 1.06–1.16; number needed to harm = 16). In 43 studies (n = 50,210), no differences were observed in the risk of UTI based on sex overall, but dapagliflozin (Farxiga) was found to be associated with an increased risk of UTI in women (OR = 1.2; 95% CI, 1.0–1.5).1

JULIA SWANSON, MD; KATHLEEN LUCIER, DO; MAIKHA JEAN-BAPTISTE, MD; and JON O. NEHER, MD, Valley Family Medicine, Renton, Washington

Address correspondence to Jon O. Neher, MD, at jon_neher@valleymed.org.

Author disclosure: No relevant financial relationships.

  1. 1.Sridharan K, Sivaramakrishnan G. Genito-urinary infectious adverse events related to sodium glucose cotransporter-2 inhibitors: a network meta-analysis and meta-regression. Expert Rev Clin Pharmacol. 2024;17(5–6):515-524.
  2. 2.Bapir R, Bhatti KH, Eliwa A, et al. Risk of urogenital infections in non-diabetic patients treated with sodium glucose transporter 2 (SGLT2) inhibitors. Systematic review and meta-analysis. Arch Ital Urol Androl. 2023;95(2):11509.
  3. 3.Cahn A, Mosenzon O, Wiviott SD, et al. Efficacy and safety of dapagliflozin in the elderly: analysis from the DECLARE-TIMI 58 study. Diabetes Care. 2020;43(2):468-475.
  4. 4.Dave CV, Schneeweiss S, Patorno E. Association of sodium-glucose transporter 2 inhibitor treatment with risk of hospitalization with Fournier gangrene among men. JAMA Intern Med. 2019;179(11):1587-1590.

Clinical Inquiries provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review. The strength of recommendations and the level of evidence for individual studies are rated using criteria developed by the Evidence-Based Medicine Working Group (https://www.cebm.net).

The complete database of evidence-based questions and answers is copyrighted by FPIN. If interested in submitting questions or writing answers for this series, go to https://www.fpin.org or email questions@fpin.org.

Copyright © Family Physicians Inquiries Network. Used with permission.

This series is coordinated by John E. Delzell Jr., MD, MSPH, associate medical editor.

A collection of FPIN’s Clinical Inquiries published in AFP is available at https://www.aafp.org/afp/fpin.

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