Can Semaglutide Cause Fungal Infections?
Semaglutide does not directly cause fungal infections, but SGLT-2 inhibitors (a different class of diabetes medication) are associated with genital mycotic infections—this distinction is critical as these drug classes are often confused in clinical practice.
Key Evidence on Semaglutide and Fungal Infections
Direct Evidence from Guidelines
The most recent cardiovascular guidelines explicitly address adverse effects of both GLP-1 receptor agonists (like semaglutide) and SGLT-2 inhibitors, making clear distinctions between these drug classes:
SGLT-2 inhibitors may increase the risk of urinary tract infection, genital mycotic infection, hypovolemia, and acute kidney injury, according to the 2025 ACC/AHA guidelines 1.
The most frequently reported adverse effects of semaglutide are gastrointestinal, including nausea, vomiting, diarrhea, and gastrointestinal reflux—with no mention of fungal infections 2.
The 2020 ACC expert consensus on novel therapies for cardiovascular risk reduction lists genital fungal infections as an adverse effect to monitor with SGLT-2 inhibitors, but this is not listed for GLP-1 receptor agonists like semaglutide 1.
Mechanism and Clinical Context
The mechanistic difference is important:
SGLT-2 inhibitors cause glucosuria (glucose in urine), which creates a favorable environment for fungal growth in the genitourinary tract 1.
Semaglutide works through GLP-1 receptor agonism, causing delayed gastric emptying and enhancing insulin secretion—mechanisms that do not predispose to fungal infections 2.
Common Clinical Pitfall
The most important caveat: Many patients with type 2 diabetes are prescribed both semaglutide AND an SGLT-2 inhibitor concurrently for their complementary cardiovascular and renal benefits 1. If a patient on semaglutide develops a genital fungal infection, the culprit is likely the SGLT-2 inhibitor, not the semaglutide.
Immunocompromised Patients: A Different Consideration
While semaglutide itself doesn't cause fungal infections, patients with diabetes have baseline increased infection risk:
Fungal infections in general occur more commonly in immunocompromised patients, including those with poorly controlled diabetes 3, 4, 5.
However, this represents the underlying disease state (diabetes) rather than a medication effect of semaglutide specifically.
Clinical Recommendations
When evaluating a patient on semaglutide with a suspected fungal infection:
Review the complete medication list to identify if an SGLT-2 inhibitor (canagliflozin, dapagliflozin, empagliflozin, ertugliflozin) is also being used 1.
For genital mycotic infections in patients on SGLT-2 inhibitors, standard antifungal therapy (typically topical azoles) is appropriate while continuing the SGLT-2 inhibitor if the infection is mild 1.
Semaglutide does not need to be discontinued for fungal infections, as it is not the causative agent 2.
Monitor for gastrointestinal adverse effects with semaglutide, which are common, rather than fungal complications 2, 6.