From the Research
For recurrent bacterial vaginosis (BV), boric acid suppositories are typically recommended at a dose of 600 mg inserted vaginally once daily for 30 days, as this regimen has shown a satisfactory response in 92 of 93 available patients, according to a recent study 1. This treatment approach may be used after standard antibiotic treatment or as an alternative when antibiotics have failed. The use of boric acid in this context is supported by its ability to restore vaginal acidity and disrupt bacterial biofilms that protect BV-causing bacteria. It is crucial to use pharmaceutical-grade boric acid in vegetable cellulose capsules specifically designed for vaginal use, as oral boric acid is toxic if ingested. Some potential side effects may include mild vaginal burning or irritation. Patients should avoid sexual intercourse during treatment or have partners use condoms to prevent reinfection. If symptoms persist after treatment, patients should consult their healthcare provider, as persistent BV may require different approaches or indicate another condition. Key considerations in the management of recurrent BV include the potential for vaginal candidiasis as a complication of prolonged antibiotic prophylaxis, necessitating frequent antifungal rescue or prophylaxis, as noted in the study 1. Given the high recurrence rate of BV, maintenance therapy with boric acid suppositories, such as 600 mg twice weekly for several months, may be necessary to prevent recurrence, although the optimal duration of maintenance therapy requires further study. In clinical practice, the choice of treatment should prioritize the most recent and highest quality evidence available, with consideration of patient-specific factors and preferences. For instance, a study from 2 also supports the use of boric acid suppositories in the treatment of recurrent BV, highlighting the importance of biofilm disruption in achieving and maintaining cure. However, the most recent and highest quality study 1 provides the strongest evidence for the recommended dosing regimen. Ultimately, the management of recurrent BV should be individualized, with careful monitoring and adjustment of treatment as needed to optimize outcomes and minimize the risk of complications.