(083) The Association of Urinary Tract Infections with Anti-Androgen Medications: A Claims Database Analysis
Authors: Agrawal P , Pupo D , Soogoor A , Gilliam K , Kohn T , Rubin R , Clifton M , Uloko M 
Published: February 2024

Abstract

Introduction
Urinary tract infections (UTI) are highly prevalent among women, with 27% having recurrence within six months. While initial antibiotic treatment resolves symptoms for a subset of women; 20-40% experience symptom recurrence. Recent work has identified androgen receptors in the vestibule and vaginal mucosa, and the correlation between androgen deficiency and hormonally mediated vestibulodynia (HMV), frequently misdiagnosed as UTI, is widely accepted as a potential pathophysiological mechanism.

Objective
We sought to characterize rates of UTIs with anti-androgen medications utilizing a national claims database.

Methods
The TriNetX database was queried from May 2023 with selection criteria based on ICD-10 codes (Figure 1). The primary study outcome was a risk of UTI after anti-androgen medication within 2 weeks to 1-year from at least 3 anti-androgen medication prescriptions. We defined a 2-week lag period after the last medication prescription based on the assumption that UTI diagnosed immediately after an anti-androgen medication prescription was likely due to factors other than the medication. Moreover, other medications prescribed for UTIs were not included in the analysis due to their indication for various infections in addition to UTIs. Recurrent UTI (rUTI) was defined as greater than 2 diagnoses of UTI within 2-weeks to 6-months, or greater than 3 diagnoses of UTI within 2-weeks to 1-year of medication prescription.

Results
Our query identified 418,117 females aged 18 – 51 years with at least 3 anti-androgen prescriptions in the last 5 years; 209,669 females had 3-6 prescriptions; 94,193 females had 7-10 prescriptions; 45,624 females had 11-14 prescriptions; and 61,941 females had ≥ 15 prescriptions. Risk of UTI between two weeks-1 year after anti-androgen prescriptions was significantly higher compared to propensity-score matched controls (13.2% vs 10.2%; Risk Ratio (RR) 1.3, 95% Confidence Interval (CI) [1.28 – 1.32]). Significant difference in UTI-free survival was observed between the two groups (Hazard ration (HR) = 1.10, 95% CI [1.09 – 1.12]) (Figure 2). Compared to those with 3-6 prescriptions, propensity-score matched groups of those with 7-10, 11-14, or ≥ 15 prescriptions had significantly lower RR of UTIs within 2-weeks to 1-year from prescriptions (RR 7-10 vs 3-6 0.91, 95% CI [0.88-0.94]; RR 11-14 vs 3-6 0.90 [0.86-0.95]; RR ≥ 15 vs 3-6 0.88 [0.85-0.91]) (Figure 3). RR of UTI within 2-weeks to 1-year from prescriptions was comparable between propensity-score matched groups of 7-10, 11-14, and ≥ 15 prescriptions (RR 11-14 vs 7-10 1.03, 95% CI [0.98-1.08]; RR ≥ 15 vs 7-10 0.97, 95% CI [0.94-1.01]; RR ≥ 15 vs 11-14 0.96, 95% CI [0.91-1.01]).

Conclusions
The risk of UTI is notably higher with the use of anti-androgen medications. Further clinical studies are needed to further elucidate this correlation with the goal of including vulvar physiology and vulvar conditions in the diagnostic work up of recurrent UTIs.

Disclosure
No.