Hypothesis / aims of study
This study hypothesized that daily supplementation with Manosar® (a combination of D-mannose and proanthocyanidins) could reduce the incidence of recurrent urinary tract infections (UTIs) postcoital in sexually active women. The primary aim was to assess the reduction in UTI episodes, while secondary objectives included evaluating treatment adherence, safety, sexual function, and quality of life.
Study design, materials and methods
This prospective, observational, pilot study was conducted at a single center over six months. The study included 26 women, aged 18-45, with recurrent UTIs linked to sexual activity. Participants received daily supplementation with Manosar® (2g D-mannose, 140mg proanthocyanidins, and other components such as vitamins C and E). The primary endpoint was the incidence of UTIs during follow-up, and secondary endpoints included adherence, safety, and sexual function as assessed by FSFI (Female Sexual Function Index), CSFQ-14 (Changes in Sexual Function Questionnaire), EQ-5D (Quality of Life Index), and PGI (Patient Global Impression of Improvement). The study was approved by the Ethics Committee, and informed consent was obtained from all participants.
Results
The average age of participants was 28.58 years, with an average of 3.15 UTIs in the prior six months.
At the study's conclusion, 53.58% of women reported no new postcoital UTI episodes, and 26.9% had only one episode. In total, 80.76% of participants did not meet the criteria for recurrent UTIs by the study's end (Table 1).
22 out of 24 clinical episodes were microbiologically documented, with 63.64% testing positive for pathogens, mainly Klebsiella aerogenes (42.86%) and Escherichia coli (22.7%).
High adherence was observed, with 90.91% of women achieving over 80% adherence at three months, and 85.71% at six months. One participant reported mild vaginal dryness.
Regarding sexual function, the FSFI questionnaire (range 2-36 points) showed a mean score of 27.78 (SD = 4.62) at the study's conclusion, with no significant differences between visits (p = 0.877). About one-third of participants maintained baseline sexual dysfunction (FSFI < 26.55) throughout the study. Similarly, the CSFQ-14 indicated a slight improvement in sexual function, though there were no significant differences between visits (p ≥ 0.05). Quality of life measures, including the EVA (health) and EQ-5D severity index, showed no significant changes during the study. However, PGI scores indicated that 80.95% of participants reported global improvement by the final visit, with no statistical differences between visits (Table 1). Additionally, patients with adherence over 80% showed a better progression in the CSFQ-14 (p = 0.03) (Table 2).
Interpretation of results
The findings suggest that Manosar® supplementation is an effective approach for preventing recurrent postcoital UTIs. The extended-release formulation ensures sustained urinary concentrations of D-mannose and proanthocyanidins, which play a crucial role in inhibiting bacterial adhesion, thereby preventing recurrent infections. The high adherence rate (90.91%) highlights the importance of treatment compliance for achieving positive outcomes, which is further supported by the patients' reports of improvement, as measured by PGI (80.95%).
The results also suggest that Manosar® does not negatively impact sexual function, with stable FSFI scores despite the recurrence of UTIs. Moreover, the favorable safety profile, with minimal adverse events, emphasizes the potential of D-mannose as a safer alternative to broad-spectrum antibiotics, which are associated with significant side effects like diarrhea and colitis.