Does Ozempic (Semaglutide) Cause Urinary Tract Infections?
Ozempic (semaglutide) is not associated with an increased risk of urinary tract infections (UTIs) based on current evidence and guidelines.
Evidence on GLP-1 Receptor Agonists and UTIs
The 2025 Standards of Care in Diabetes specifically outlines the adverse effects of GLP-1 receptor agonists (the class to which Ozempic belongs) and does not list UTIs among them 1. The documented side effects for GLP-1 RAs include:
- Gastrointestinal effects
- Potential thyroid C-cell tumors (in rodents)
- Risk of ileus
- Pancreatitis (though causality not established)
- Biliary disease
- Diabetic retinopathy concerns
Unlike SGLT2 inhibitors (a different class of diabetes medications), which have been associated with genital mycotic infections, Ozempic has no documented association with urinary tract infections in clinical guidelines.
SGLT2 Inhibitors vs. GLP-1 RAs
It's important to distinguish between different classes of diabetes medications:
- SGLT2 inhibitors (like dapagliflozin, empagliflozin) work by increasing glucose excretion in urine and have been associated with genital mycotic infections 1, 2
- GLP-1 receptor agonists (like semaglutide/Ozempic) work through incretin pathways and do not increase urinary glucose excretion
Research has shown that:
- Dapagliflozin (an SGLT2 inhibitor) showed a slightly increased risk of UTIs in some studies (OR 1.17,95% CI 1.04-1.31) 3
- A real-world observational study found higher UTI incidence with SGLT2 inhibitors (33.49%) compared to non-SGLT2 inhibitors (11.72%) 4
UTI Risk Factors and Management
For patients concerned about UTIs, the following risk factors should be considered:
- Female gender
- Older age
- History of recurrent UTIs
- Urinary catheterization
- Poor glycemic control
According to UTI treatment guidelines, if a patient develops a UTI (regardless of cause), appropriate management includes:
- Obtaining urine culture before starting therapy for suspected UTI, especially in complicated cases 5
- Using first-line antibiotics such as nitrofurantoin, fosfomycin, or trimethoprim-sulfamethoxazole for uncomplicated UTIs 5
- Treating for 5-7 days for uncomplicated infections and 7-14 days for complicated infections 5
Clinical Bottom Line
When prescribing Ozempic (semaglutide):
- Patients should be counseled about common side effects (primarily gastrointestinal)
- UTIs are not a recognized side effect of Ozempic
- If UTI symptoms develop, they should be evaluated and treated according to standard guidelines
- Patients with diabetes have a generally higher baseline risk of UTIs regardless of medication
If a patient is concerned about medication-related UTI risk, SGLT2 inhibitors would be more concerning than GLP-1 RAs like Ozempic.