SGLT2 Inhibitors and Genital Infections: A Hospital-Based Prospective study in a Tertiary Care Setting

SGLT2 Inhibitors and Genital Infections: A Hospital-Based Prospective study in a Tertiary Care Setting | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article SGLT2 Inhibitors and Genital Infections: A Hospital-Based Prospective study in a Tertiary Care Setting Numan Malik, Anushree Deshpande, Prasad MR This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6459870/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background “Type 2 diabetes mellitus (T2DM) is a long-term metabolic condition linked to a higher risk of infections”. Sodium-glucose cotransporter-2 (SGLT2) inhibitors, an antihyperglycemic drug class, have demonstrated efficacy in glycemic control and cardiovascular benefits. However, their use has been linked to an increased incidence of genital infections due to enhanced glucosuria. Purpose of the study: To assess the incidence of genital infections in patients using SGLT2 inhibitors. Methods A prospective observational study was carried out in patients on SGLT2 inhibitors, either as monotherapy or combination therapy, were included. Data on demographic characteristics, incidence of genital infections, symptoms, and associated factors were collected. IBM SPSS version 20 was used to carry out statistical analysis, with chi-square and logistic regression tests applied to evaluate associations. Results Among 200 patients (60% male, 40% female), 33% developed genital infections, with a greater frequency in females (36.25%) in contrast to males (30.8%). The most prescribed SGLT2 inhibitor was dapagliflozin (98.5%). Common symptoms included itching (58.3% in males, 41.7% in females), burning sensation (63% in males, 37% in females), and pain during urination (57.9% in males, 42.1% in females). Vaginal discharge was exclusive to females (p = 0.001), while abdominal pain was significantly more common in males (p = 0.005). No significant association was found between infection incidence and demographic factors. Conclusion Genital infections are a notable adverse effect of SGLT2 inhibitors, with a slightly higher risk in females. Patient education on hygiene and early symptom recognition is crucial in mitigating infection risk. SGLT2 Inhibitors Genital Infections Type 2 Diabetes Mellitus Dapagliflozin Urinary Glucose Infection Risk 1. Introduction “Type 2 diabetes mellitus (T2DM) is a long-term metabolic condition characterized by the body's incapacity to properly take up insulin from the pancreas and a compromised capacity to regulate blood glucose levels, which can lead to hyperglycemia”. A number of pathophysiological abnormalities, such as deficiencies in the pancreatic secretion of insulin, elevated hepatic glucose output, and enhanced insulin resistance in the muscles, are characteristics of type 2 diabetes [ 1 , 2 ] . The IDF Diabetes Atlas (2021) reports that 10.5% of individuals aged 20 to 79 are living with diabetes, with nearly half of them unaware of their condition. Shockingly, it is projected that by 2045, one in eight people, totalling 783 million individuals, will be affected by diabetes, representing a 46% increase from current levels, as forecasted by the IDF [ 3 ] . Patients with Diabetes mellitus are twice as likely to develop infections as compared to people without diabetes [ 4 ] . SGLT2 inhibitors are genuinely a revolutionary family of oral antihyperglycemic medications in the treatment of type 2 DM. In addition to facilitating glycaemic control, these medications also aid in weight loss and cardiovascular protection by directly interfering with renal glucose reabsorption pathways. These are SGLT2 reversible inhibitors that significantly lower serum glucose levels and glucose reabsorption without the need for insulin [ 5 , 6 , 7 ] . Following metformin, SGLT2 inhibitors are advised as a second-line treatment for patients with heart failure, chronic kidney disease, clinical atherosclerotic cardiovascular disease (ASCVD), or those who require significant hypoglycemia reduction, aim to minimize weight gain, or seek to promote weight loss [ 8 , 9 ] . Dapagliflozin, canagliflozin, and empagliflozin are SGLT2 inhibitors that are often used to treat type2 diabetes, Yet, they are linked to an increased risk of genitourinary tract infections, which exacerbates the fact that diabetics are already more vulnerable than the general population [ 10 ] . Infections in the genitourinary tract seem to be the most frequent side effect of SGLT2 inhibitor treatment. Increases in urine glucose can lead to a faster rate of microbial growth, which raises the risk of UTI and asymptomatic bacteriuria [ 11 ] . Approximately 2.5–6.5% of individuals treated with SGLT2 inhibitors experience genital infections, according to clinical research, while 1% of patients in placebo groups experience the same problem. According to a thorough review of 113 randomized controlled studies with a total of over 105,000 adults, the genital tract infections were reported by 4.51% of patients on SGLT2 inhibitors compared to 1.01% of patients on placebo [ 12 ] . Genital infections were 3–4 times more common in patients on SGLT2 inhibitors compared to those getting a placebo in phase 3 cardiovascular outcome trials. With a reported annual prevalence of 3.2–6.9% among women, genital infections were more prevalent in women than in men on SGLT2 inhibitors [ 13 ] . Various factors, particularly female sex and diabetes especially in cases of poor glycemic control have been linked to an elevated risk of genital infections in the general population [ 14 , 15 ] . The purpose of this research was to assess the incidence of genital infections in patients using SGLT2 inhibitors. 2. Methodology A prospective, observational study was conducted from August 2024 to February 2025 at outpatient department of Cardiology and General medicine at tertiary care hospital. Prior to the commencement of the study, Approval was obtained from the Institutional Ethics Committee. The study aimed to assess the incidence of genital infections among patients using SGLT2 inhibitors who attended the outpatient department (OPD) of a tertiary care hospital. The study included all patients on SGLT2 inhibitors, either as monotherapy or in combination with other medications, who visited the Cardiology and General Medicine OPD. Eligible patients were those aged 18 years or older, receiving SGLT2 inhibitors either alone or in combination with other drugs, and who provided written informed consent. Patients were excluded if they had incomplete demographic or laboratory data, a prior history of genital fungal infections before initiating SGLT2 inhibitors, or congenital genital anomalies. The study methodology involved several key steps, beginning with the identification and screening of patients based on the study criteria. After patient selection, the incidence of genital infections among SGLT2 inhibitor users was assessed based on clinical manifestation. Demographic details, medical history, SGLT2 inhibitor dosage and symptoms of genital infections were recorded. Patient follow-up was conducted to track infection incidence and progression. Relevant data were systematically sorted and categorized. 3. Statistical analysis IBM SPSS version 20 was used to carry out statistical analysis. Descriptive statistics, such as frequencies and percentages, were employed to summarize patient demographics and clinical characteristics. Additionally, chi-square tests compared the distribution of symptoms between males and females. To evaluate the impact of demographic factors on infection risk, logistic regression analysis was conducted to assess relationships between infection occurrence and variables such as age, gender, education level, occupation, and social habits. A significance level of p < 0.05 and 95% confidence intervals were applied to ensure statistical reliability. 4. Results The study included 200 patients, predominantly aged between 51–60 years (33.5%), followed closely by the 61–70 age group (29.5%). Males constituted 60% of the sample, with females making up the remaining 40%. In terms of educational background, the majority of patients held an undergraduate degree (45.5%), secondary education (40.5%), while only a small percentage (14%) had primary education. Occupationally, the study revealed that housewives (27.5%) and professionals (27%) were the most prevalent groups, closely followed by retired individuals (23%) and those engaged in agriculture (22.5%). Social habits varied among the participants, with 38% reporting no tobacco or alcohol consumption, while 31% used tobacco, 7.5% consumed alcohol, and 23.5% indulged in both. The vast majority of patients (92%) were prescribed a 10 mg dose of SGLT2 inhibitors, with dapagliflozin emerging as the most commonly prescribed medication (98.5%). In terms of comorbidities, diabetes mellitus (DM) was highly prevalent, often coexisting with conditions such as coronary artery disease (CAD) or hypertension (HTN). Notably, 68% of patients were diabetic, while the remaining 32% were non-diabetic as presented in Table 1. As per Table 2 , The incidence of genital infections among SGLT2 inhibitor users was 33% (66 out of 200 patients). Gender-wise, the infection rate was slightly greater in females (36.25%) than in males (30.8%). This indicates that female patients on SGLT2 inhibitors may be at slightly increased risk of getting genital infections. The analysis of symptoms showed no significant variation between males and females in terms of itching (28 males, 58.3%; 20 females, 41.7%; p = 0.787), burning sensation (17 males, 63%; 10 females, 37%; p = 0.735), and pain during urination (22 males, 57.9%; 16 females, 42.1%; p = 0.768). However, vaginal discharge was found exclusively in females (10 females; p = 0.001), while abdominal pain was significantly more prevalent in males (25 males, 83.3%; 5 females, 16.7%; p = 0.005). Redness was more commonly reported by females (13 females, 56.5%; 10 males, 43.5%), however the variation was not statistically significant (p = 0.086). In summary, while most symptoms were shared between genders, vaginal discharge emerged as a key symptom in females, while abdominal pain was more frequently reported by males as detailed in Table 3 . The analysis of symptom onset timing revealed that the majority of symptoms manifested within the initial three months of SGLT2 inhibitor use. More specifically, 42.1% of male patients and 57.9% of female patients exhibited symptoms within the first month, while 46.4% of males and 53.6% of females experienced symptoms between one and three months. The Pearson correlation analysis indicated no significant disparity between males and females with regard to of symptom onset (p = 0.727), implying that the progression of infection follows a similar timeline across genders as shown in Table 4 . Logistic regression analysis was conducted to evaluate the effect of demographic factors on the risk of genital infections. The analysis included variables like age, gender, education level, occupation, and social habits. However, none of these factors demonstrated a significant relationship with infection risk (all p-values = 0.999 or 1.000). This indicates that genital infections among SGLT2 inhibitor users are probably more affected by physiological or clinical factors than by demographic characteristics as shown in Table 5 . 5. Discussion Our study found a 33% occurrence of genital infections among individuals using SGLT2 inhibitors, with a higher frequency in females (36.25%) in contrast to males (30.8%). This observation is consistent with the results of previous study [ 13 ] , who noted a heightened vulnerability among female SGLT2 inhibitor users due to anatomical variances, alterations in vaginal microbiota, and prolonged exposure to glucose in the genital region. Their study underscored that woman with inadequate glycemic control faced a significantly elevated risk of genital infections, a pattern also evident in our investigation. Despite the higher prevalence among females, our data underscores that male patients are also significantly impacted, underscoring the importance of awareness and monitoring in both genders. The symptoms identified in our study were consistent across genders, with itching, burning sensation, and pain during urination being the most prevalent. However, vaginal discharge was only observed in female patients (p = 0.001), while abdominal pain was significantly more common in males (p = 0.005). These results concur with those of the earlier study [ 4 ] , which highlighted that females taking SGLT2 inhibitors are more likely to experience vaginal candidiasis, while males tend to present with balanitis and other genital discomforts. Understanding these gender-specific manifestations is essential in clinical practice, as it can facilitate early diagnosis and the implementation of targeted intervention strategies. The logistic regression analysis in our study did not reveal any significant demographic predictors, such as age, education, occupation, or social habits, for genital infections. This aligns with previous study [ 10 ] findings, which suggest that genital infections in SGLT2 inhibitor users are primarily associated with increased glucosuria rather than demographic factors. However, another previous study [ 4 ] has highlighted the importance of good hygiene practices and patient education in reducing infection rates. This emphasizes the need to educate patients on proper hygiene, early symptom recognition, and prompt medical intervention to minimize the risk of infections. Our study found a 33% incidence of genital infections among SGLT2 inhibitor users, with 36.25% in females and 30.8% in males. This aligns with findings from Benoy et al. (2025), who reported a 19.3% incidence of urogenital infections (UGIs) among SGLT2 inhibitor users in a tertiary care hospital in India. Their study identified 15.6% bacterial infections and 3.6% fungal infections, whereas our study showed a higher overall infection rate. This disparity could result from variations in sample sizes, follow-up duration, and regional factors affecting infection susceptibility. A key observation in our study was the higher infection prevalence in females compared to males. Similarly, Benoy et al. (2025) found that females had a slightly higher incidence (21%) compared to males (18%), though the difference was not statistically significant. This trend supports previous research indicating increased susceptibility in females due to anatomical differences, vaginal microbiota, and prolonged exposure to glucose in the genital region [ 16 ] . 6. Conclusion This study highlights the association between SGLT2 inhibitor use and an increased risk of genital infections, with a slightly higher prevalence in females. No significant correlation was found between infection risk and demographic factors. Instead, factors such as glycosuria and immune response may play a key role. Patient education on hygiene, early symptom recognition, and timely medical intervention is essential to reduce infection risks. While SGLT2 inhibitors provide effective glycemic and cardiovascular benefits, further research is needed to explore preventive strategies, patient education and to improve the patient safety during long-term therapy. 7. Limitations This single-centre study has limited generalizability, and the short follow-up period may not capture long-term trends. The lack of microbiological testing limits pathogen identification, and the absence of a control group further restricts the findings. 8. Future Directions Future studies should include multi-centre trials, longer follow-ups, and microbiological analysis. Research on hygiene education, preventive strategies, and comparative studies with other antidiabetic drugs can help refine infection risk management. Exploring dose adjustments and combination therapies may enhance patient safety. Tabe 1: Baseline characteristics of patients Characteristics Category Frequency n=200 (%) Age (years) 21-30 3(1.5) 31-40 9(4.5) 41-50 35(17.5) 51-60 67(33.5) 61-70 59(29.5) >70 27(13.5) Gender Male 120(60) Female 80(40) Education Primary 28(14) Secondary 81(40.5) UG 91(45.5) Occupation Professional 54(27) Agriculture 45(22.5) Retired 46(23) Housewife 55(27.5) Social Habits Alcohol 15(7.5) Tobacco 62(31) Alcohol & Tobacco 47(23.5) None 76(38) Dose of SGLT2 inhibitor 5mg 16(8) 10mg 184(92) SGLT2 inhibitor used Dapagliflozin 197 Empagliflozin 2 Remogliflozin 1 Comorbidities DM & CAD 63 CAD 41 HTN & DM 31 DM 29 HTN & CAD 19 DM & CKD 7 CAD & CKD 3 HTN+ DM +CAD 3 HTN + DM +CKD 3 HTN + CAD + CKD 1 Patient Type Diabetic 136 Non-diabetic 64 Table 2: Incidence rate of Genital infections Infections No. of Infected Incidence rate (%) Genital Infections 66/200 33 Males 37/120 30.8 Females 29/80 36.25 Table 3: Symptoms of infections in Male and Females Symptoms Gender Chi-square p value Male n (%) Female n (%) Itching Yes 28 (58.3) 20 (41.7) 0.073 0.787 No 92 (60.5) 60 (39.5) Burning Sensation Yes 17 (63.0) 10 (37.0) 0.114 0.735 No 103 (59.5) 70 (40.5) Discharge Yes 0 (0.0) 10 (100.0) 15.789 0.001* No 120 (63.2) 70 (36.8) Pain during urination Yes 22 (57.9) 16 (42.1) 0.087 0.768 No 98 (60.5) 64 (39.5) Redness Yes 10 (43.5) 13 (56.5) 2.956 0.086 No 110 (62.1) 67 (37.9) Abdominal pain Yes 25 (83.3) 5 (16.7) 8.007 0.005* No 95 (55.9) 75 (44.1) Note: Chi square test to check the association (*) Significant association at p < 0.05 Table 4: Pearson Correlation for Onset of symptoms in Infected Males and Females Onset of Symptoms Gender Chi-square p value Male n (%) Female n (%) 0.122 0.727 < 1 Month 16 (42.1) 22 (57.9) 1-3 Months 13 (46.4) 15 (53.6) Table 5: Logistic regression for Demographic factors associated with genital infections Variable Odds Ratio p value Age 0.003 0.999 HbA1C 0.018 1.000 Gender Male Ref. Female 0.000 1.000 Occupation Professional Ref. Agriculture 3643 0.999 Retired 1146 0.999 Housewife 0.000 1.000 Education Primary Ref. Secondary 0.000 0.998 UG 0.000 0.999 Social Habits Smoking Yes Ref. No 0.525 1.000 Tobacco Yes Ref. No 1534 0.997 Alcohol Yes Ref. No 6219 1.000 Abbreviations SGLT2 - Sodium-glucose cotransporter-2 DM - Diabetes Mellitus CAD - Coronary Artery Disease HTN - Hypertension CKD - Chronic Kidney Disease. Declarations Conflict of Interest: The authors have no relevant financial or non-financial interests to disclose. Funding: No funding was received for conducting this study. References Thong KY, Yadagiri M, Barnes DJ, Morris DS, Chowdhury TA, Chuah LL, Robinson AM, Bain SC, Adamson KA, Ryder RE. Clinical risk factors predicting genital fungal infections with sodium–glucose cotransporter 2 inhibitor treatment: The ABCD nationwide dapagliflozin audit. Primary care diabetes. 2018 Feb 1;12(1):45-50. Laverty B, Puthezhath Jayanandan S, Smyth S. Understanding the relationship between sleep and quality of life in type 2 diabetes: A systematic review of the literature. Journal of Health Psychology. 2023 Jul;28(8):693-710. International Diabetes Federation.IDF Diabetes Atlas, 10th edn. Brussels, Belgium: International Diabetes Federation, 2021. Unnikrishnan AG, Kalra S, Purandare V, Vasnawala H. Genital infections with sodium glucose cotransporter-2 inhibitors: occurrence and management in patients with type 2 diabetes mellitus. Indian journal of endocrinology and metabolism. 2018 Nov 1;22(6):837-42. Chao EC. SGLT-2 inhibitors: a new mechanism for glycemic control. Clinical Diabetes. 2014 Jan 1;32(1):4-11. Filippatos TD, Liberopoulos EN, Elisaf MS. Dapagliflozin in patients with type 2 diabetes mellitus. Therapeutic advances in endocrinology and metabolism. 2015 Feb;6(1):29-41. Lega IC, Bronskill SE, Campitelli MA, Guan J, Stall NM, Lam K, McCarthy LM, Gruneir A, Rochon PA. Sodium glucose cotransporter 2 inhibitors and risk of genital mycotic and urinary tract infection: a population‐based study of older women and men with diabetes. Diabetes, Obesity and Metabolism. 2019 Nov;21(11):2394-404. Engelhardt K, Ferguson M, Rosselli JL. Prevention and management of genital mycotic infections in the setting of sodium-glucose cotransporter 2 inhibitors. Annals of Pharmacotherapy. 2021 Apr;55(4):543-8. Pelletier R, Ng K, Alkabbani W, Labib Y, Mourad N, Gamble JM. Adverse events associated with sodium glucose co-transporter 2 inhibitors: an overview of quantitative systematic reviews. Therapeutic Advances in Drug Safety.2021 Jan;12:2042098621989134. Chaplin S. SGLT2 inhibitors and risk of genitourinary infections. Prescriber. 2016 Dec;27(12):26-30. Marques LP, Mendonça NA, Müller L, André AC, Madeira EP, Vieira LM. Impact of sodium-glucose cotransporter-2 inhibitors-induced glucosuria in the incidence of urogenital infection on postmenopausal women with diabetes. Postgraduate Medicine. 2020 Nov 16;132(8):697-701. SGLT-2 inhibitor-related genital tract infections and UTIs. Reactions Weekly 1976 , 10 (2023). https://doi.org/10.1007/s40278-023-46739-0 Nakhleh A, Zloczower M, Gabay L, Shehadeh N. Effects of sodium glucose co-transporter 2 inhibitors on genital infections in female patients with type 2 diabetes mellitus–Real world data analysis. Journal of Diabetes and its Complications. 2020 Jul 1;34(7):107587. Sobel JD. Vulvovaginal candidosis. The Lancet. 2007 Jun 9;369(9577):1961-71. Hine JL, de Lusignan S, Burleigh D, Pathirannehelage S, McGovern A, Gatenby P, Jones S, Jiang D, Williams J, Elliot AJ, Smith GE. Association between glycaemic control and common infections in people with type 2 diabetes: a cohort study. Diabetic Medicine. 2017 Apr;34(4):551-7. Binoy A, Fischer L. Association of SGLT2 Inhibitors and Urogenital Infections in Patients Attending a Tertiary Care Hospital: A Prospective Observational Study. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6459870","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":455937502,"identity":"72e1dd82-9211-44cc-a9f7-143dcdbc5926","order_by":0,"name":"Numan Malik","email":"","orcid":"","institution":"KLE College of Pharmacy, KLE Academy for Higher Education and Research (KAHER) Belagavi","correspondingAuthor":false,"prefix":"","firstName":"Numan","middleName":"","lastName":"Malik","suffix":""},{"id":455937503,"identity":"cbf32b3f-a573-454c-96d9-64da4aa06943","order_by":1,"name":"Anushree Deshpande","email":"data:image/png;base64,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","orcid":"","institution":"KLE College of Pharmacy, KLE Academy for Higher Education and Research (KAHER) Belagavi","correspondingAuthor":true,"prefix":"","firstName":"Anushree","middleName":"","lastName":"Deshpande","suffix":""},{"id":455937504,"identity":"260a7e84-f5a6-42ea-889a-67b53b10ec6b","order_by":2,"name":"Prasad MR","email":"","orcid":"","institution":"J. 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Medical College, KAHER","correspondingAuthor":false,"prefix":"","firstName":"Prasad","middleName":"","lastName":"MR","suffix":""}],"badges":[],"createdAt":"2025-04-16 05:53:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6459870/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6459870/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":82811780,"identity":"7d86b913-45e5-48d5-960f-43615e1961d5","added_by":"auto","created_at":"2025-05-15 13:34:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":931319,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6459870/v1/f992ce0c-ccb3-4cad-8da2-b021ff0ba7b9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"SGLT2 Inhibitors and Genital Infections: A Hospital-Based Prospective study in a Tertiary Care Setting","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003e\u0026ldquo;Type 2 diabetes mellitus (T2DM) is a long-term metabolic condition characterized by the body's incapacity to properly take up insulin from the pancreas and a compromised capacity to regulate blood glucose levels, which can lead to hyperglycemia\u0026rdquo;. A number of pathophysiological abnormalities, such as deficiencies in the pancreatic secretion of insulin, elevated hepatic glucose output, and enhanced insulin resistance in the muscles, are characteristics of type 2 diabetes \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. The IDF Diabetes Atlas (2021) reports that 10.5% of individuals aged 20 to 79 are living with diabetes, with nearly half of them unaware of their condition. Shockingly, it is projected that by 2045, one in eight people, totalling 783\u0026nbsp;million individuals, will be affected by diabetes, representing a 46% increase from current levels, as forecasted by the IDF \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. Patients with Diabetes mellitus are twice as likely to develop infections as compared to people without diabetes \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. SGLT2 inhibitors are genuinely a revolutionary family of oral antihyperglycemic medications in the treatment of type 2 DM. In addition to facilitating glycaemic control, these medications also aid in weight loss and cardiovascular protection by directly interfering with renal glucose reabsorption pathways. These are SGLT2 reversible inhibitors that significantly lower serum glucose levels and glucose reabsorption without the need for insulin \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. Following metformin, SGLT2 inhibitors are advised as a second-line treatment for patients with heart failure, chronic kidney disease, clinical atherosclerotic cardiovascular disease (ASCVD), or those who require significant hypoglycemia reduction, aim to minimize weight gain, or seek to promote weight loss \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. Dapagliflozin, canagliflozin, and empagliflozin are SGLT2 inhibitors that are often used to treat type2 diabetes, Yet, they are linked to an increased risk of genitourinary tract infections, which exacerbates the fact that diabetics are already more vulnerable than the general population \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. Infections in the genitourinary tract seem to be the most frequent side effect of SGLT2 inhibitor treatment. Increases in urine glucose can lead to a faster rate of microbial growth, which raises the risk of UTI and asymptomatic bacteriuria \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. Approximately 2.5\u0026ndash;6.5% of individuals treated with SGLT2 inhibitors experience genital infections, according to clinical research, while 1% of patients in placebo groups experience the same problem. According to a thorough review of 113 randomized controlled studies with a total of over 105,000 adults, the genital tract infections were reported by 4.51% of patients on SGLT2 inhibitors compared to 1.01% of patients on placebo \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. Genital infections were 3\u0026ndash;4 times more common in patients on SGLT2 inhibitors compared to those getting a placebo in phase 3 cardiovascular outcome trials. With a reported annual prevalence of 3.2\u0026ndash;6.9% among women, genital infections were more prevalent in women than in men on SGLT2 inhibitors \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. Various factors, particularly female sex and diabetes especially in cases of poor glycemic control have been linked to an elevated risk of genital infections in the general population \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. The purpose of this research was to assess the incidence of genital infections in patients using SGLT2 inhibitors.\u003c/p\u003e"},{"header":"2. Methodology","content":"\u003cp\u003eA prospective, observational study was conducted from August 2024 to February 2025 at outpatient department of Cardiology and General medicine at tertiary care hospital. Prior to the commencement of the study, Approval was obtained from the Institutional Ethics Committee. The study aimed to assess the incidence of genital infections among patients using SGLT2 inhibitors who attended the outpatient department (OPD) of a tertiary care hospital. The study included all patients on SGLT2 inhibitors, either as monotherapy or in combination with other medications, who visited the Cardiology and General Medicine OPD.\u003c/p\u003e \u003cp\u003eEligible patients were those aged 18 years or older, receiving SGLT2 inhibitors either alone or in combination with other drugs, and who provided written informed consent. Patients were excluded if they had incomplete demographic or laboratory data, a prior history of genital fungal infections before initiating SGLT2 inhibitors, or congenital genital anomalies.\u003c/p\u003e \u003cp\u003eThe study methodology involved several key steps, beginning with the identification and screening of patients based on the study criteria. After patient selection, the incidence of genital infections among SGLT2 inhibitor users was assessed based on clinical manifestation. Demographic details, medical history, SGLT2 inhibitor dosage and symptoms of genital infections were recorded. Patient follow-up was conducted to track infection incidence and progression. Relevant data were systematically sorted and categorized.\u003c/p\u003e"},{"header":"3. Statistical analysis","content":"\u003cp\u003eIBM SPSS version 20 was used to carry out statistical analysis. Descriptive statistics, such as frequencies and percentages, were employed to summarize patient demographics and clinical characteristics. Additionally, chi-square tests compared the distribution of symptoms between males and females. To evaluate the impact of demographic factors on infection risk, logistic regression analysis was conducted to assess relationships between infection occurrence and variables such as age, gender, education level, occupation, and social habits. A significance level of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 and 95% confidence intervals were applied to ensure statistical reliability.\u003c/p\u003e"},{"header":"4. Results","content":"\u003cp\u003eThe study included 200 patients, predominantly aged between 51\u0026ndash;60 years (33.5%), followed closely by the 61\u0026ndash;70 age group (29.5%). Males constituted 60% of the sample, with females making up the remaining 40%. In terms of educational background, the majority of patients held an undergraduate degree (45.5%), secondary education (40.5%), while only a small percentage (14%) had primary education. Occupationally, the study revealed that housewives (27.5%) and professionals (27%) were the most prevalent groups, closely followed by retired individuals (23%) and those engaged in agriculture (22.5%). Social habits varied among the participants, with 38% reporting no tobacco or alcohol consumption, while 31% used tobacco, 7.5% consumed alcohol, and 23.5% indulged in both. The vast majority of patients (92%) were prescribed a 10 mg dose of SGLT2 inhibitors, with dapagliflozin emerging as the most commonly prescribed medication (98.5%). In terms of comorbidities, diabetes mellitus (DM) was highly prevalent, often coexisting with conditions such as coronary artery disease (CAD) or hypertension (HTN). Notably, 68% of patients were diabetic, while the remaining 32% were non-diabetic as presented in Table\u0026nbsp;1.\u003c/p\u003e \u003cp\u003eAs per Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e2\u003c/span\u003e, The incidence of genital infections among SGLT2 inhibitor users was 33% (66 out of 200 patients). Gender-wise, the infection rate was slightly greater in females (36.25%) than in males (30.8%). This indicates that female patients on SGLT2 inhibitors may be at slightly increased risk of getting genital infections.\u003c/p\u003e \u003cp\u003eThe analysis of symptoms showed no significant variation between males and females in terms of itching (28 males, 58.3%; 20 females, 41.7%; p\u0026thinsp;=\u0026thinsp;0.787), burning sensation (17 males, 63%; 10 females, 37%; p\u0026thinsp;=\u0026thinsp;0.735), and pain during urination (22 males, 57.9%; 16 females, 42.1%; p\u0026thinsp;=\u0026thinsp;0.768). However, vaginal discharge was found exclusively in females (10 females; p\u0026thinsp;=\u0026thinsp;0.001), while abdominal pain was significantly more prevalent in males (25 males, 83.3%; 5 females, 16.7%; p\u0026thinsp;=\u0026thinsp;0.005). Redness was more commonly reported by females (13 females, 56.5%; 10 males, 43.5%), however the variation was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.086). In summary, while most symptoms were shared between genders, vaginal discharge emerged as a key symptom in females, while abdominal pain was more frequently reported by males as detailed in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eThe analysis of symptom onset timing revealed that the majority of symptoms manifested within the initial three months of SGLT2 inhibitor use. More specifically, 42.1% of male patients and 57.9% of female patients exhibited symptoms within the first month, while 46.4% of males and 53.6% of females experienced symptoms between one and three months. The Pearson correlation analysis indicated no significant disparity between males and females with regard to of symptom onset (p\u0026thinsp;=\u0026thinsp;0.727), implying that the progression of infection follows a similar timeline across genders as shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eLogistic regression analysis was conducted to evaluate the effect of demographic factors on the risk of genital infections. The analysis included variables like age, gender, education level, occupation, and social habits. However, none of these factors demonstrated a significant relationship with infection risk (all p-values\u0026thinsp;=\u0026thinsp;0.999 or 1.000). This indicates that genital infections among SGLT2 inhibitor users are probably more affected by physiological or clinical factors than by demographic characteristics as shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e"},{"header":"5. Discussion","content":"\u003cp\u003eOur study found a 33% occurrence of genital infections among individuals using SGLT2 inhibitors, with a higher frequency in females (36.25%) in contrast to males (30.8%). This observation is consistent with the results of previous study \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e, who noted a heightened vulnerability among female SGLT2 inhibitor users due to anatomical variances, alterations in vaginal microbiota, and prolonged exposure to glucose in the genital region. Their study underscored that woman with inadequate glycemic control faced a significantly elevated risk of genital infections, a pattern also evident in our investigation. Despite the higher prevalence among females, our data underscores that male patients are also significantly impacted, underscoring the importance of awareness and monitoring in both genders.\u003c/p\u003e \u003cp\u003eThe symptoms identified in our study were consistent across genders, with itching, burning sensation, and pain during urination being the most prevalent. However, vaginal discharge was only observed in female patients (p\u0026thinsp;=\u0026thinsp;0.001), while abdominal pain was significantly more common in males (p\u0026thinsp;=\u0026thinsp;0.005). These results concur with those of the earlier study \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e, which highlighted that females taking SGLT2 inhibitors are more likely to experience vaginal candidiasis, while males tend to present with balanitis and other genital discomforts. Understanding these gender-specific manifestations is essential in clinical practice, as it can facilitate early diagnosis and the implementation of targeted intervention strategies.\u003c/p\u003e \u003cp\u003eThe logistic regression analysis in our study did not reveal any significant demographic predictors, such as age, education, occupation, or social habits, for genital infections. This aligns with previous study \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e findings, which suggest that genital infections in SGLT2 inhibitor users are primarily associated with increased glucosuria rather than demographic factors. However, another previous study \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e has highlighted the importance of good hygiene practices and patient education in reducing infection rates. This emphasizes the need to educate patients on proper hygiene, early symptom recognition, and prompt medical intervention to minimize the risk of infections.\u003c/p\u003e \u003cp\u003eOur study found a 33% incidence of genital infections among SGLT2 inhibitor users, with 36.25% in females and 30.8% in males. This aligns with findings from Benoy et al. (2025), who reported a 19.3% incidence of urogenital infections (UGIs) among SGLT2 inhibitor users in a tertiary care hospital in India. Their study identified 15.6% bacterial infections and 3.6% fungal infections, whereas our study showed a higher overall infection rate. This disparity could result from variations in sample sizes, follow-up duration, and regional factors affecting infection susceptibility. A key observation in our study was the higher infection prevalence in females compared to males. Similarly, Benoy et al. (2025) found that females had a slightly higher incidence (21%) compared to males (18%), though the difference was not statistically significant. This trend supports previous research indicating increased susceptibility in females due to anatomical differences, vaginal microbiota, and prolonged exposure to glucose in the genital region \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e "},{"header":"6. Conclusion","content":"\u003cp\u003eThis study highlights the association between SGLT2 inhibitor use and an increased risk of genital infections, with a slightly higher prevalence in females. No significant correlation was found between infection risk and demographic factors. Instead, factors such as glycosuria and immune response may play a key role. Patient education on hygiene, early symptom recognition, and timely medical intervention is essential to reduce infection risks. While SGLT2 inhibitors provide effective glycemic and cardiovascular benefits, further research is needed to explore preventive strategies, patient education and to improve the patient safety during long-term therapy.\u003c/p\u003e"},{"header":"7. Limitations","content":"\u003cp\u003eThis single-centre study has limited generalizability, and the short follow-up period may not capture long-term trends. The lack of microbiological testing limits pathogen identification, and the absence of a control group further restricts the findings.\u003c/p\u003e"},{"header":"8. Future Directions","content":"\u003cp\u003eFuture studies should include multi-centre trials, longer follow-ups, and microbiological analysis. Research on hygiene education, preventive strategies, and comparative studies with other antidiabetic drugs can help refine infection risk management. Exploring dose adjustments and combination therapies may enhance patient safety.\u003c/p\u003e \u003cp\u003e\u003cstrong\u003e\u003cem\u003eTabe 1: Baseline characteristics of patients\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"612\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency n=200 (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003e21-30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e3(1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003e31-40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e9(4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003e41-50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e35(17.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003e51-60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e67(33.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003e61-70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e59(29.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003e\u0026gt;70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e27(13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e120(60)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e80(40)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e28(14)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e81(40.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003eUG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e91(45.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eProfessional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e54(27)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003eAgriculture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e45(22.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003eRetired\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e46(23)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003eHousewife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e55(27.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocial Habits\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003eAlcohol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e15(7.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003eTobacco\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e62(31)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003eAlcohol \u0026amp; Tobacco\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e47(23.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e76(38)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDose of SGLT2 inhibitor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003e5mg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e16(8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003e10mg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e184(92)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSGLT2 inhibitor used\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDapagliflozin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e197\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003eEmpagliflozin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003eRemogliflozin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"10\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDM \u0026amp; CAD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003eCAD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003eHTN \u0026amp; DM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003eDM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003eHTN \u0026amp; CAD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003eDM \u0026amp; CKD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003eCAD \u0026amp; CKD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003eHTN+ DM +CAD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003eHTN + DM +CKD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003eHTN + CAD + CKD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatient Type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDiabetic\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e136\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003eNon-diabetic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eTable 2:\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003eIncidence rate of Genital infections\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"613\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfections\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo. of Infected\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIncidence rate (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGenital Infections\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e66/200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMales\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e37/120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e30.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemales\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e29/80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e36.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eTable 3: Symptoms of infections in Male and Females\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"627\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSymptoms\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 259px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eChi-square\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eItching\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e28 (58.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e20 (41.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.073\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e0.787\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e92 (60.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e60 (39.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBurning Sensation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e17 (63.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e10 (37.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e0.735\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e103 (59.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e70 (40.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDischarge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e10 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e15.789\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e120 (63.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e70 (36.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePain during urination\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e22 (57.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e16 (42.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.087\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e0.768\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e98 (60.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e64 (39.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRedness\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e10 (43.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e13 (56.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2.956\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e0.086\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e110 (62.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e67 (37.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbdominal pain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e25 (83.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e5 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e8.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e0.005*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e95 (55.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e75 (44.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: Chi square test to check the association (*) Significant association at p \u0026lt; 0.05\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eTable 4: Pearson Correlation for Onset of symptoms in Infected Males and Females\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"601\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOnset of Symptoms\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 260px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChi-square\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.122\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.727\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 1 Month\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e16 (42.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e22 (57.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1-3 Months\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e13 (46.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e15 (53.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eTable 5: Logistic regression for Demographic factors associated with genital infections\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"626\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOdds Ratio\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e0.999\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHbA1C\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProfessional\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAgriculture\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e3643\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e0.999\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRetired\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e1146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e0.999\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHousewife\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrimary\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSecondary\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e0.998\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUG\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e0.999\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocial Habits\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoking\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e0.525\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTobacco\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e1534\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e0.997\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlcohol\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e6219\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 209px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Abbreviations","content":"\u003col\u003e\n \u003cli\u003eSGLT2 - Sodium-glucose cotransporter-2\u003c/li\u003e\n \u003cli\u003eDM - Diabetes Mellitus\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;CAD - Coronary Artery Disease\u003c/li\u003e\n \u003cli\u003eHTN - Hypertension\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eCKD - Chronic Kidney Disease.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u0026nbsp;\u003c/strong\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eNo funding was received for conducting this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eThong KY, Yadagiri M, Barnes DJ, Morris DS, Chowdhury TA, Chuah LL, Robinson AM, Bain SC, Adamson KA, Ryder RE. Clinical risk factors predicting genital fungal infections with sodium\u0026ndash;glucose cotransporter 2 inhibitor treatment: The ABCD nationwide dapagliflozin audit. Primary care diabetes. 2018 Feb 1;12(1):45-50.\u003c/li\u003e\n\u003cli\u003eLaverty B, Puthezhath Jayanandan S, Smyth S. Understanding the relationship between sleep and quality of life in type 2 diabetes: A systematic review of the literature. Journal of Health Psychology. 2023 Jul;28(8):693-710.\u003c/li\u003e\n\u003cli\u003eInternational Diabetes Federation.IDF Diabetes Atlas, 10th edn. Brussels, Belgium: International Diabetes Federation, 2021.\u003c/li\u003e\n\u003cli\u003eUnnikrishnan AG, Kalra S, Purandare V, Vasnawala H. Genital infections with sodium glucose cotransporter-2 inhibitors: occurrence and management in patients with type 2 diabetes mellitus. Indian journal of endocrinology and metabolism. 2018 Nov 1;22(6):837-42.\u003c/li\u003e\n\u003cli\u003eChao EC. SGLT-2 inhibitors: a new mechanism for glycemic control. Clinical Diabetes. 2014 Jan 1;32(1):4-11.\u003c/li\u003e\n\u003cli\u003eFilippatos TD, Liberopoulos EN, Elisaf MS. Dapagliflozin in patients with type 2 diabetes mellitus. Therapeutic advances in endocrinology and metabolism. 2015 Feb;6(1):29-41.\u003c/li\u003e\n\u003cli\u003eLega IC, Bronskill SE, Campitelli MA, Guan J, Stall NM, Lam K, McCarthy LM, Gruneir A, Rochon PA. Sodium glucose cotransporter 2 inhibitors and risk of genital mycotic and urinary tract infection: a population‐based study of older women and men with diabetes. Diabetes, Obesity and Metabolism. 2019 Nov;21(11):2394-404.\u003c/li\u003e\n\u003cli\u003eEngelhardt K, Ferguson M, Rosselli JL. Prevention and management of genital mycotic infections in the setting of sodium-glucose cotransporter 2 inhibitors. Annals of Pharmacotherapy. 2021 Apr;55(4):543-8.\u003c/li\u003e\n\u003cli\u003ePelletier R, Ng K, Alkabbani W, Labib Y, Mourad N, Gamble JM. Adverse events associated with sodium glucose co-transporter 2 inhibitors: an overview of quantitative systematic reviews. Therapeutic Advances in Drug Safety.2021 Jan;12:2042098621989134.\u003c/li\u003e\n\u003cli\u003eChaplin S. SGLT2 inhibitors and risk of genitourinary infections. Prescriber. 2016 Dec;27(12):26-30.\u003c/li\u003e\n\u003cli\u003eMarques LP, Mendon\u0026ccedil;a NA, M\u0026uuml;ller L, Andr\u0026eacute; AC, Madeira EP, Vieira LM. Impact of sodium-glucose cotransporter-2 inhibitors-induced glucosuria in the incidence of urogenital infection on postmenopausal women with diabetes. Postgraduate Medicine. 2020 Nov 16;132(8):697-701.\u003c/li\u003e\n\u003cli\u003eSGLT-2 inhibitor-related genital tract infections and UTIs. \u003cem\u003eReactions Weekly\u003c/em\u003e\u003cstrong\u003e1976\u003c/strong\u003e, 10 (2023). https://doi.org/10.1007/s40278-023-46739-0\u003c/li\u003e\n\u003cli\u003eNakhleh A, Zloczower M, Gabay L, Shehadeh N. Effects of sodium glucose co-transporter 2 inhibitors on genital infections in female patients with type 2 diabetes mellitus\u0026ndash;Real world data analysis. Journal of Diabetes and its Complications. 2020 Jul 1;34(7):107587.\u003c/li\u003e\n\u003cli\u003eSobel JD. Vulvovaginal candidosis. The Lancet. 2007 Jun 9;369(9577):1961-71.\u003c/li\u003e\n\u003cli\u003eHine JL, de Lusignan S, Burleigh D, Pathirannehelage S, McGovern A, Gatenby P, Jones S, Jiang D, Williams J, Elliot AJ, Smith GE. Association between glycaemic control and common infections in people with type 2 diabetes: a cohort study. Diabetic Medicine. 2017 Apr;34(4):551-7.\u003c/li\u003e\n\u003cli\u003eBinoy A, Fischer L. Association of SGLT2 Inhibitors and Urogenital Infections in Patients Attending a Tertiary Care Hospital: A Prospective Observational Study.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"the-egyptian-journal-of-internal-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [The Egyptian Journal of Internal Medicine](https://ejim.springeropen.com/)","snPcode":"43162","submissionUrl":"https://submission.springernature.com/new-submission/43162/3","title":"The Egyptian Journal of Internal Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"SGLT2 Inhibitors, Genital Infections, Type 2 Diabetes Mellitus, Dapagliflozin, Urinary Glucose, Infection Risk","lastPublishedDoi":"10.21203/rs.3.rs-6459870/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6459870/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003e\u0026ldquo;Type 2 diabetes mellitus (T2DM) is a long-term metabolic condition linked to a higher risk of infections\u0026rdquo;. Sodium-glucose cotransporter-2 (SGLT2) inhibitors, an antihyperglycemic drug class, have demonstrated efficacy in glycemic control and cardiovascular benefits. However, their use has been linked to an increased incidence of genital infections due to enhanced glucosuria.\u003c/p\u003e\u003ch2\u003ePurpose of the study:\u003c/h2\u003e \u003cp\u003eTo assess the incidence of genital infections in patients using SGLT2 inhibitors.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA prospective observational study was carried out in patients on SGLT2 inhibitors, either as monotherapy or combination therapy, were included. Data on demographic characteristics, incidence of genital infections, symptoms, and associated factors were collected. IBM SPSS version 20 was used to carry out statistical analysis, with chi-square and logistic regression tests applied to evaluate associations.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong 200 patients (60% male, 40% female), 33% developed genital infections, with a greater frequency in females (36.25%) in contrast to males (30.8%). The most prescribed SGLT2 inhibitor was dapagliflozin (98.5%). Common symptoms included itching (58.3% in males, 41.7% in females), burning sensation (63% in males, 37% in females), and pain during urination (57.9% in males, 42.1% in females). Vaginal discharge was exclusive to females (p\u0026thinsp;=\u0026thinsp;0.001), while abdominal pain was significantly more common in males (p\u0026thinsp;=\u0026thinsp;0.005). No significant association was found between infection incidence and demographic factors.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eGenital infections are a notable adverse effect of SGLT2 inhibitors, with a slightly higher risk in females. Patient education on hygiene and early symptom recognition is crucial in mitigating infection risk.\u003c/p\u003e","manuscriptTitle":"SGLT2 Inhibitors and Genital Infections: A Hospital-Based Prospective study in a Tertiary Care Setting","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-15 13:26:28","doi":"10.21203/rs.3.rs-6459870/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-30T16:31:46+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-28T21:51:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"305103234362015342101630143666490823870","date":"2025-06-23T17:26:25+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-06T16:09:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"126481212197263202787199289095340781112","date":"2025-06-05T11:14:13+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-13T11:37:39+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-21T09:38:54+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-21T02:41:23+00:00","index":"","fulltext":""},{"type":"submitted","content":"The Egyptian Journal of Internal Medicine","date":"2025-04-16T05:50:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"the-egyptian-journal-of-internal-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [The Egyptian Journal of Internal Medicine](https://ejim.springeropen.com/)","snPcode":"43162","submissionUrl":"https://submission.springernature.com/new-submission/43162/3","title":"The Egyptian Journal of Internal Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cbae5315-8a7e-4d5e-bd9a-3a52db30ce0d","owner":[],"postedDate":"May 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-07-15T08:23:46+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-15 13:26:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6459870","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6459870","identity":"rs-6459870","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}