Purpose: The purpose of this article it to educate the audience on the importance of early and aggressive treatment of mycotic genital infections in patients with diabetes mellitus. Because of many of the new treatments for diabetes mellitus, serious mycotic infections and/or complications have become more common. Traditional conservative treatment of these mycotic infections has not been effective and has resulted in more serious, even deadly infections and/or complications such as Fournier’s gangrene. Although still relatively rare, the extreme risks associated with insufficiently treating mycotic genial infections should warrant more aggressive treatment guidelines in the initial treatment of mycotic genital infections.
Method: The purpose of this review of literature is to determine if there is a relationship between the treatment of diabetes, especially with SGLT-2 inhibitors, and increased mycotic genital infections and the possible relationship with associated severe skin infections such as necrotizing fasciitis and Fournier’s gangrene. A PubMed and Google Scholar search was conducted with search terms of “diabetes mellitus” “genital infections” “sodium glucose cotransporter-2 (SGLT-2) inhibitors”, and a secondary search including “necrotizing fasciitis” and “Fournier’s gangrene.” Sixty-six articles were initially investigated which provide background information on diabetes and mycotic infections in general. Using the secondary search criteria, the articles were honed down to ten articles involving SGLT-2 inhibitors and Fournier’s gangrene.
Results: Research provides evidence that diabetic patients are at an increased risk of mycotic genital infections. Multiple studies show evidence that suggests an even greater rate of mycotic infections in diabetic patients being treated with SGLT-2 inhibitors, so much so that in 2015 the Food and Drug Administration (FDA) issued a class-wide warning against SGLT-2 inhibitors and increased risk of mycotic genitourinary infections.
Conclusion: The findings of this literature review suggest that in patients with diabetes there is an increased rate of mycotic genital infections, and possibly a slightly increased rate of bacterial infections. However, there is insufficient evidence to support a direct correlation between these mycotic infections and extreme bacterial infections. Therefore, there is insufficient evidence to support aggressive treatment of mycotic genital infections in order to prevent severe bacterial infections. Due to the extreme nature of infections such as necrotizing fasciitis and Fournier’s gangrene, this would be an excellent area for further research and clinical trials.
Bigham R. Aggressive Treatment of Genital Infections in Patients with Diabetes. Lynchburg Journal of Medical Science. 2021; 3(4).
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