Anti-Androgen therapy may increase UTI risk in women

The risk for urinary tract infections (UTIs) may be higher among women taking anti-androgen medications, in particular those who take 3 to 6 prescriptions, according to a presentation at the 24th Annual Fall Scientific Meeting of the Sexual Medicine Society of North America.¹

The risk for a UTI between 2 weeks and 1 year following treatment with anti-androgen prescription, compared with control-matched women, was significantly higher (13.2% vs 10.2%; risk ratio (RR) 1.3; 95% CI, 1.28-1.32). Further, the UTI-free survival demonstrated an HR of 1.10 (95% CI, 1.09-1.12; P < .0001).

“But the clinical significance of this association is still a matter of debate,” Dianelis Pupo, a second-year medical student at Herbert Wertheim College of Medicine, said during the presentation.

While UTIs are very prevalent among women, with 27% experiencing a recurrence in 6 months, the symptoms are not always exclusive to UTIs, and can present in other areas, such as hormonally mediated vestibulodynia (HMV). Lower urinary tract symptoms may include urgency, burning, and frequency.

Therefore, the investigators aimed to analyze UTI rates in 418,117 pre- or peri-menopausal women taking anti-androgen medications, using the TriNetX Database.

To be included in the study, women had to be aged 18 to 51 years, have received 3 or more anti-androgen prescriptions within the last 5 years, and have had 5 or more care-instances within the last 5 years. Women were not eligible if they ever had any long-term use of antibiotics.

Anti-androgen medications included Drospirenone, Desogestrel, Ethynodiol, Norgestimate, Ethinyl estradiol, Levonorgestrel, Norgestrel; or Spironolactone, Flutamide, Finasteride; or Isotretinoin.

Patients were propensity matched for age; race; ethnicity; diagnosis of acute pyelonephritis; urolithiasis; obstructive and reflux uropathy; disorders of the bladder or urethra; incontinence; diabetes mellitus; polycystic ovarian syndrome; and being overweight or obese.

Risk for UTI after anti-androgen medication within 2 weeks to 1 year from at least 3 anti-androgen medication prescriptions served as the study’s primary outcome.

In total, the study included 209,669 females who had 3 to 6 anti-androgen prescriptions; 94,193 females who had 7 to 10 prescriptions; 45,624 females who had 11 to 14 prescriptions; and 61,941 females who had 15 or more prescriptions.

The risk for a UTI between 2 weeks and 1 year following treatment with anti-androgen prescription, compared with control-matched women, was significantly higher (13.2% vs 10.2%; risk ratio (RR) 1.3; 95% CI, 1.28-1.32). Further, the UTI-free survival demonstrated an HR of 1.10 (95% CI, 1.09-1.12; P < .0001).

When comparing against women who had 3 to 6 anti-androgen prescriptions, propensity-score matched groups had significantly lower risk for UTIs within 2 weeks to 1 year from prescriptions in those who had 7 to 10 prescriptions (RR, 0.91; 95% CI, 0.88-0.94), women who had 11 to 14 prescriptions (RR, 0.90; 95% CI, 0.86-0.95), and females who had 15 or more prescriptions (RR, 0.88; 95% CI, 0.85-0.91). These risks were comparable between the 7 to 10, 11 to 14, and 15 or more prescription groups

“Another way of seeing it is that we found that taking more prescriptions decreases the risk of being diagnosed with UTIs,” Pupo said, concluding that patients’ risk was particularly increased during the initiation of therapy.

“This also highlights the importance of following up and counseling of the patients during this period,” Pupo concluded. “Which brings us back to our hypothesis at the beginning, a lot of these women actually have HMV and being diagnosed with UTI. And so, we would still propose that further studies be done to correlate with this idea and this comparison, with the objective of vulvar physiology and vulvar conditions in the diagnostic work-up of recurrent UTIs.”

Reference

1. Agrawal P, Pupo D, Soogoor A, et al. The Association of Urinary Tract Infections with Anti-Androgen Medications: A Claims Database Analysis. Presented at: 24th Annual Fall Scientific Meeting SMSNA; November 16-18, 2023; San Diego, CA. Abstract 83.