From the Guidelines
Boric acid used in the vagina (PV) can pose significant risks, including vaginal irritation, burning, and redness, and its use should be carefully considered due to potential systemic absorption and toxicity, especially with prolonged or frequent use 1. When considering the use of boric acid vaginally, it's crucial to weigh the potential benefits against the risks, particularly for conditions like non-albicans VVC, where it may be recommended as a second-line treatment after other options have failed. The recommended regimen of 600 mg of boric acid in a gelatin capsule, administered vaginally once daily for 2 weeks, has shown clinical and mycologic eradication rates of approximately 70% 1. However, safety data regarding the long-term use of this regimen are lacking, and potential risks such as systemic absorption leading to toxicity symptoms like nausea, vomiting, diarrhea, skin rash, and in severe cases, kidney damage or shock, must be considered. Some key points to consider when using boric acid vaginally include:
- Following proper dosing and administration to minimize risks
- Using applicators to reduce skin contact and potential irritation
- Discontinuing use if irritation or other adverse effects occur
- Avoiding use during pregnancy due to potential harm to the fetus
- Avoiding use if there are open wounds in the vaginal area
- Only using boric acid under the guidance of a healthcare provider and not as a first-line treatment.
From the FDA Drug Label
Warnings For external Vaginal use only. Do not use • If you never had a vaginal yeast infection diagnosed by your doctor.• If you are allergic to any of the ingredients. When using this product • mild increase in vaginal irritation or burning may occur. Stop use and ask a doctor if • If symptoms persist or inflammation increases after 7 days of use or if the infection increases.• Increase in abdominal pain or foul discharge. The risks of PV boric acid include:
- Vaginal irritation or burning
- Inflammation
- Abdominal pain
- Foul discharge It is also recommended to ask a doctor if symptoms persist or worsen after 7 days of use. Additionally, individuals who are pregnant or breastfeeding should consult a health professional before use 2.
From the Research
Risks of PV Boric Acid
- There are limited studies on the risks of PV boric acid, but available evidence suggests that it may be a safe and effective treatment for bacterial vaginosis 3, 4.
- A study published in 2009 found that the addition of boric acid to suppressive antimicrobial therapy for recurrent bacterial vaginosis resulted in no adverse effects 4.
- However, the use of boric acid as a treatment for bacterial vaginosis is not without risks, as it may not be effective for all women and may require repeated treatment 5, 6.
- The standard treatment for bacterial vaginosis, metronidazole, has been shown to have a high failure rate and recurrence rate, which may be associated with antibiotic resistance and the inability to eradicate polymicrobial biofilms 7, 5.
- Alternative strategies, such as the use of antimicrobial substances, probiotics, and acidifying agents, may be necessary to improve treatment efficacy and prevent recurrences 5, 6.
Comparison with Standard Treatments
- Boric acid has been compared to metronidazole in the treatment of bacterial vaginosis, with some studies suggesting that it may be a safe and effective alternative 3, 4.
- Clindamycin has also been shown to be a safe and effective treatment for bacterial vaginosis, with a similar failure rate to metronidazole 7.
- The choice of treatment for bacterial vaginosis may depend on individual patient factors, such as the severity of symptoms and the presence of other health conditions 5, 6.
Future Directions
- Further studies are needed to fully understand the risks and benefits of PV boric acid as a treatment for bacterial vaginosis 3, 5, 6.
- The development of new formulation strategies and drug delivery systems may improve treatment efficacy and overcome some limitations associated with conventional products 5.
- The use of adjuvant therapy with probiotics may have a significant role in improving efficacy and preventing recurrences 6.