SGLT2i Genital Mycosis — EECC MCQ
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Correct answer: D — SGLT2 inhibitors increase urinary glucose excretion, creating a favourable environment for genital yeast infections; treat with topical antifungal (clotrimazole or miconazole) and continue empagliflozin as the HF benefit outweighs this manageable side effect
SGLT2 inhibitors cause glycosuria by blocking glucose reabsorption in the proximal convoluted tubule. The increased urinary glucose creates a favourable environment for Candida species, leading to genital mycotic infections in approximately 5-10% of patients (more common in uncircumcised men and women). These infections are generally mild and treatable with topical antifungals (clotrimazole cream, miconazole pessaries). They should NOT lead to permanent SGLT2i discontinuation, as the cardiovascular and renal benefits far outweigh this manageable adverse effect. Hygiene advice and prompt treatment are usually sufficient. Recurrent infections may warrant brief courses of oral fluconazole. The risk is higher in diabetes (due to higher urinary glucose) but also occurs in non-diabetic HF patients.
Reference: ESC (2023): HF Guidelines; BNF