Recurrent urinary tract infections (rUTIs) can significantly impact a woman's quality of life, affecting both urinary and sexual function. While intravesical treatments have shown promise, a new study published in the Journal of Sexual Medicine suggests that an oral supplement combination may offer a more convenient and effective solution.

Key Findings

1. Improved sexual function: Women taking the supplement combination showed higher Female Sexual Function Index (FSFI) scores compared to the control group after 3 months (p < 0.001).
2. Reduced urinary symptoms: The intervention group had lower International Prostate Symptom Score (IPSS) scores, indicating fewer urinary symptoms (p = 0.03).
3. Sustained benefits: Improvements in sexual and urinary symptoms were maintained even after crossover treatment.
4. Early intervention advantage: Starting the supplement combination immediately was associated with earlier improvement in both sexual (OR 3.9, p = 0.04) and urinary symptoms (OR 5.1, p = 0.01).

Study Design and Methods

This randomized, crossover pilot trial involved women with rUTIs referred to a single center between March 2022 and April 2023. Participants were randomly assigned to two groups:

1. Intervention group: Oral preparation of hyaluronic acid (HA), chondroitin sulfate, N-acetylglucosamine, and vitamin C once daily, plus a base supplement of cranberry, D-mannose, propolis extract, turmeric, and Boswellia twice daily.
2. Control group: Base supplement only.

After 3 months, the groups crossed over treatments for an additional 3 months. Participants were evaluated at baseline, 3 months, and 6 months using the FSFI and IPSS questionnaires.

Why This Matters

Recurrent UTIs affect millions of women worldwide, often leading to decreased quality of life, sexual dysfunction, and frequent antibiotic use. This study offers several important implications:

1. Non-antibiotic approach: The supplement combination provides an alternative to antibiotics, potentially reducing the risk of antibiotic resistance.
2. Dual benefit: By addressing both urinary and sexual symptoms, this treatment may offer a more comprehensive solution for women with rUTIs.
3. Convenience: An oral supplement is likely to be more acceptable to patients than intravesical treatments, potentially improving adherence.
4. Rapid improvement: The study showed benefits within 3 months, offering hope for quick symptom relief.

How It Works

The supplement combination targets multiple aspects of urinary tract health:

1. Hyaluronic acid and chondroitin sulfate: Help restore the protective glycosaminoglycan layer of the bladder wall, which is often compromised in women with rUTIs.
2. N-acetylglucosamine: Supports the production of glycosaminoglycans and may have anti-inflammatory properties.
3. Vitamin C: Helps acidify urine, creating a less hospitable environment for bacteria.
4. Base supplement ingredients: Offer additional antibacterial and anti-inflammatory effects.

Limitations and Future Research

While promising, this study has some limitations:

1. Small sample size: Larger studies are needed to confirm these findings.
2. Short follow-up: The long-term efficacy and safety of this supplement combination remain to be determined.
3. Lack of placebo control: Both groups received an active supplement, which may have influenced results.

Future research should address these limitations and explore:

1. Optimal treatment duration
2. Potential interactions with other medications
3. Efficacy in different patient populations (e.g., postmenopausal women)
4. Comparison with standard antibiotic prophylaxis

Conclusion

This study provides compelling evidence that an oral supplement combination of hyaluronic acid, chondroitin sulfate, N-acetylglucosamine, and vitamin C may significantly improve both urinary and sexual symptoms in women with recurrent UTIs. As a non-antibiotic approach, it offers a promising alternative for managing this common and distressing condition. However, larger, long-term studies are needed to fully establish its efficacy and safety profile.

References

1. Boeri L, et al. "Oral preparation of hyaluronic acid, chondroitin sulfate, N-acetylglucosamine, and vitamin C improves sexual and urinary symptoms in participants with recurrent urinary tract infections: a randomized crossover trial." Journal of Sexual Medicine, 2024;21(7):627-634. doi:10.1093/jsxmed/qdae052

2. Madersbacher H, et al. "GAG layer replenishment therapy for chronic forms of cystitis with intravesical glycosaminoglycans--a review." Neurourology and Urodynamics, 2013;32(1):9-18. doi:10.1002/nau.22256

3. Goddard JC, Janssen DAW. "Intravesical hyaluronic acid and chondroitin sulfate for recurrent urinary tract infections: systematic review and meta-analysis." International Urogynecology Journal, 2018;29(7):933-942. doi:10.1007/s00192-017-3508-z

4. Ciani O, et al. "Intravesical administration of combined hyaluronic acid (HA) and chondroitin sulfate (CS) for the treatment of female recurrent urinary tract infections: a European multicentre nested case-control study." BMJ Open, 2016;6(3):e009669. doi:10.1136/bmjopen-2015-009669