Can Wegovy Cause UTI? Evidence and Guidance

Wegovy (semaglutide 2.4 mg) is a GLP-1 receptor agonist licensed for chronic weight management in adults with obesity or overweight with weight-related comorbidities. Whilst the medication is associated with well-documented gastrointestinal side effects, some patients wonder whether it might increase the risk of urinary tract infections (UTIs). Understanding the relationship between Wegovy and urinary health is important for patients and healthcare professionals. This article examines the current evidence, explores potential mechanisms, and provides practical guidance on recognising and managing urinary symptoms during Wegovy treatment, based on UK clinical guidance and regulatory data.

Understanding Wegovy and Its Common Side Effects

Wegovy (semaglutide 2.4 mg) is a glucagon-like peptide-1 (GLP-1) receptor agonist licensed by the MHRA for chronic weight management in adults with obesity or overweight with weight-related comorbidities. According to NICE Technology Appraisal 875, it is recommended for use within specialist weight management services for people with a BMI of at least 35 kg/m² (or 30 kg/m² with weight-related comorbidities) and can be used for up to 2 years.

Administered as a once-weekly subcutaneous injection, Wegovy works by mimicking the natural hormone GLP-1, which regulates appetite and food intake through actions on the brain's satiety centres.

The medication has demonstrated significant efficacy in clinical trials, with patients achieving substantial weight loss when combined with lifestyle modifications. However, like all medicines, Wegovy is associated with a range of side effects that patients and healthcare professionals should understand before initiating treatment.

The most commonly reported adverse effects include gastrointestinal symptoms such as nausea, vomiting, diarrhoea, constipation, and abdominal pain. These effects are typically most pronounced during dose escalation and often diminish over time as the body adjusts to the medication. According to the Summary of Product Characteristics (SmPC), severe gastrointestinal adverse reactions can lead to dehydration and, in rare cases, acute kidney injury. Other frequent side effects include:

• Headache and dizziness

• Fatigue and decreased energy

• Injection site reactions

• Dyspepsia and gastro-oesophageal reflux

More serious but less common adverse effects include pancreatitis, gallbladder disease, and hypoglycaemia (particularly in patients taking concomitant diabetes medications). The MHRA and EMA continue to monitor the safety profile of semaglutide products, and healthcare professionals are encouraged to report suspected adverse reactions through the Yellow Card Scheme. Understanding these established side effects provides important context when considering whether Wegovy might be associated with urinary tract infections.

The Link Between Wegovy and Urinary Tract Infections

There is no established direct causal link between Wegovy (semaglutide) and urinary tract infections (UTIs) based on current clinical evidence and regulatory data. UTIs are not listed among the common or uncommon adverse effects in the Summary of Product Characteristics (SmPC) for Wegovy, nor have they been identified as a significant safety signal in post-marketing surveillance by the MHRA or EMA.

Clinical trials evaluating semaglutide for weight management, including the pivotal STEP (Semaglutide Treatment Effect in People with obesity) programme published in the New England Journal of Medicine (2021), did not demonstrate a statistically significant increase in UTI incidence compared to placebo groups. This distinguishes Wegovy from some other diabetes medications, such as SGLT2 inhibitors (sodium-glucose co-transporter-2 inhibitors), which are known to increase UTI risk through their mechanism of increasing urinary glucose excretion.

However, individual patient reports of UTIs whilst taking Wegovy do exist, which may reflect several factors. Weight loss itself can lead to physiological changes that might temporarily affect urinary patterns. Additionally, patients prescribed Wegovy often have obesity-related comorbidities, including type 2 diabetes, which independently increases UTI susceptibility. The presence of multiple risk factors makes it challenging to attribute UTIs specifically to the medication.

It is important to distinguish between correlation and causation. Whilst some patients may experience UTIs during Wegovy treatment, this does not necessarily indicate the medication is responsible. Healthcare professionals should assess each case individually, considering the patient's complete medical history, concurrent medications, and other UTI risk factors before attributing symptoms to Wegovy. If you develop urinary symptoms whilst taking Wegovy, it is essential to seek medical evaluation rather than assuming the medication is the cause.

Why GLP-1 Receptor Agonists May Affect Urinary Health

GLP-1 receptor agonists like Wegovy work primarily through central and peripheral mechanisms that regulate appetite, gastric emptying, and glucose homeostasis. Unlike SGLT2 inhibitors, they do not directly alter renal glucose handling or increase urinary glucose excretion, which is the primary mechanism by which some diabetes medications increase UTI risk.

However, several indirect pathways warrant consideration. Gastrointestinal side effects, particularly diarrhoea and vomiting, are common with GLP-1 receptor agonists and can lead to dehydration if fluid intake is inadequate. As noted in the Wegovy SmPC, severe gastrointestinal adverse reactions may lead to dehydration with potential risk of acute kidney injury. Dehydration reduces urine output and concentration, potentially creating an environment more conducive to bacterial colonisation of the urinary tract. Concentrated urine provides less frequent flushing of bacteria from the bladder, one of the body's natural defence mechanisms against UTIs.

Weight loss and metabolic changes associated with Wegovy treatment may also influence urinary health indirectly. As patients lose weight, changes in body composition, mobility, and personal hygiene practices may occur. Improved mobility might actually reduce UTI risk in some patients.

Glycaemic improvements in patients with type 2 diabetes taking Wegovy could theoretically reduce UTI risk, as elevated blood glucose levels are associated with increased susceptibility to infections, including UTIs. Better glucose control typically supports immune function and reduces the glucose available in urine that can promote bacterial growth.

Currently, there is insufficient evidence to suggest that GLP-1 receptor agonists directly compromise urinary tract defences or increase infection susceptibility through their pharmacological actions. Any observed associations are more likely related to secondary factors such as hydration status or pre-existing patient risk factors.

Recognising UTI Symptoms While Taking Wegovy

Urinary tract infections can affect any part of the urinary system, including the kidneys, ureters, bladder, and urethra, though most infections involve the lower urinary tract (bladder and urethra). Recognising UTI symptoms promptly is important for all patients, including those taking Wegovy, to ensure timely treatment and prevent complications.

Common symptoms of a lower urinary tract infection (cystitis) include:

• A persistent, strong urge to urinate

• A burning sensation or pain when passing urine (dysuria)

• Passing frequent, small amounts of urine

• Cloudy, dark, or strong-smelling urine

• Blood in the urine (haematuria), which may appear pink or red

• Pelvic discomfort or pressure, particularly in women

• A feeling of incomplete bladder emptying

Upper urinary tract infections (pyelonephritis), affecting the kidneys, are more serious and may present with additional symptoms such as high fever, chills, nausea, vomiting, and pain in the back, side, or groin. These symptoms require urgent medical attention.

Patients taking Wegovy should be particularly attentive to hydration status, as gastrointestinal side effects may mask or complicate symptom recognition. For instance, new or worsening nausea, especially when accompanied by fever or back pain, could indicate an ascending UTI rather than just a medication side effect. Similarly, if you are experiencing reduced fluid intake due to appetite suppression, you may be at higher risk of concentrated urine, which can intensify UTI symptoms.

It is important not to dismiss urinary symptoms as simply another side effect of Wegovy. Whilst the medication is not known to cause UTIs directly, any new urinary symptoms warrant proper medical assessment. Certain groups, including pregnant women, men, and catheterised patients, should have a particularly low threshold for seeking advice. Untreated UTIs can progress to more serious kidney infections or, in rare cases, lead to sepsis, particularly in patients with diabetes or other comorbidities common among those prescribed Wegovy.

When to Seek Medical Advice

Prompt medical evaluation is essential if you develop symptoms suggestive of a urinary tract infection whilst taking Wegovy. Early diagnosis and treatment can prevent complications and ensure that symptoms are not indicative of a more serious condition.

You should contact your GP or practice nurse if you experience:

• Painful, burning, or stinging sensations when urinating

• Increased urinary frequency or urgency that is new or unusual

• Blood in your urine

• Cloudy or foul-smelling urine

• Lower abdominal or pelvic pain

• Mild fever or general malaise

Seek urgent medical attention (contact NHS 111 or attend an urgent treatment centre or A&E) if you develop:

• High fever (above 38°C) with chills or rigors

• Severe pain in your back, side, or groin

• Persistent vomiting that prevents you from keeping down fluids or oral medicines

• Confusion or altered mental state

• Symptoms of sepsis, including rapid heartbeat, rapid breathing, or feeling extremely unwell

These symptoms may indicate an upper urinary tract infection or systemic infection requiring immediate assessment and possible hospital admission.

For patients with diabetes or other conditions that compromise immune function, a lower threshold for seeking medical advice is appropriate. Additionally, if you have recurrent UTIs (defined by NICE as three or more in 12 months, or two or more in 6 months), discuss this pattern with your GP, as it may warrant further investigation regardless of Wegovy use.

It's important to note that visible blood in the urine (haematuria) that persists after UTI treatment, or occurs without other UTI symptoms, requires urgent GP assessment as it may be a sign of other conditions requiring investigation under NICE suspected cancer referral guidelines (NG12).

When consulting your GP, inform them that you are taking Wegovy, along with details of any other medications, as this information is important for appropriate antibiotic selection and assessment of potential drug interactions. Do not stop taking Wegovy without medical advice, as UTIs are treatable conditions that should not necessarily interrupt your weight management treatment.

Managing Urinary Health on Wegovy Treatment

Maintaining good urinary health whilst taking Wegovy involves practical strategies that can reduce UTI risk and support overall wellbeing during weight management treatment. These measures are beneficial for all patients, regardless of whether there is a direct link between the medication and UTIs.

Hydration is paramount. Aim to drink adequate fluids throughout the day, typically 6-8 glasses (1.5–2 litres) of water daily unless advised otherwise by your healthcare team. This is particularly important given that Wegovy can cause gastrointestinal side effects that may lead to fluid loss. Adequate hydration ensures regular bladder emptying and dilutes urine, both of which help prevent bacterial colonisation. If you experience nausea, try sipping water frequently in small amounts rather than drinking large volumes at once.

Good hygiene practices are essential for preventing UTIs:

• Wipe from front to back after using the toilet

• Urinate soon after sexual intercourse

• Avoid using irritating feminine products, douches, or perfumed soaps in the genital area

• Wear breathable cotton underwear and avoid tight-fitting clothing

• Do not delay urination when you feel the urge

Dietary considerations may also support urinary health. Some evidence suggests that cranberry products may help prevent recurrent UTIs in some individuals, though NICE guidance (NG112) notes the evidence is limited and it should not replace medical treatment. Avoiding excessive caffeine and alcohol can reduce bladder irritation.

Monitor your symptoms and maintain open communication with your healthcare team. Keep track of any urinary changes, particularly during the dose escalation phase of Wegovy treatment. If you have pre-existing risk factors for UTIs, such as diabetes, previous recurrent infections, or urinary tract abnormalities, discuss preventive strategies with your GP.

If you experience severe vomiting or diarrhoea that prevents adequate fluid intake, seek medical advice about temporarily pausing your Wegovy treatment to prevent dehydration and potential kidney problems.

Finally, continue your Wegovy treatment as prescribed unless specifically advised otherwise by your healthcare team. UTIs are common, treatable conditions that should not automatically necessitate discontinuation of weight management therapy. Your healthcare team can help you balance the significant benefits of Wegovy for weight loss and metabolic health with appropriate management of any urinary symptoms that may arise.

Scientific References

1. Wegovy 0.25 mg, FlexTouch solution for injection in pre-filled pen - Summary of Product Characteristics.
2. Semaglutide for managing overweight and obesity. Technology Appraisal Guidance TA875.
3. Once-Weekly Semaglutide in Adults with Overweight or Obesity.
4. GLP-1 receptor agonists: reminder of the potential side effects and to be aware of the potential for misuse.

Frequently Asked Questions