Prevalence of urinary tract infections in women with vulvovaginal atrophy and the impact of vaginal prasterone on the rate of urinary tract infections.

Objective: The aims of this study were to assess the prevalence of urinary tract infections (UTI) in women newly diagnosed with vulvovaginal atrophy (VVA) versus women without VVA and to evaluate the potential of vaginal prasterone to be used in postmenopausal VVA women with UTI as prophylaxis to reduce the future UTI risk. As a first subgroup analysis, women using aromatase inhibitors, medications that stop the production of estrogen were analyzed. As a second subgroup analysis, we looked at women with diabetes to investigate whether the same prophylaxis approach should be considered.

Methods: This observational retrospective inception cohort study was conducted using the Integrated Dataverse open-source claims database with data from February 2015 through January 2020.

Results: A total of 22,245 women treated with prasterone for a minimum of 12 weeks were matched to women without any prescribed VVA-related treatment. Overall, women treated with prasterone have a significantly lower UTI prevalence compared to those untreated (6.58% vs 12.3%; P < 0.0001). The highest difference in UTI prevalence among the prasterone treated and untreated women was observed in those aged 65-74 (7.15% vs 16.2%; P < 0.0001). Among aromatase inhibitor users and women with diabetes, those treated with prasterone have a significantly lower UTI prevalence (4.90% vs 9.79%; P < 0.01 and 14.59% vs 20.48%; P < 0.0001, respectively).

Conclusions: This study suggests that intravaginal prasterone may be a good candidate for prophylaxis in postmenopausal women with UTI to reduce future UTI risk, including for women taking aromatase inhibitors and women with diabetes. This study is based on real-world evidence and warrants further investigation in a clinical setting.