Boric Acid for Bacterial Vaginosis (BV)

Written By: Jillian Foglesong Stabile MD, FAAFP

Bacterial vaginosis (BV) is an overgrowth of the normal bacteria that live in the vagina, leading to an infection in the vaginal tissues. It's a common yet misunderstood condition that can be uncomfortable for many. While antibiotics are widely used to treat BV, some people turn to alternative remedies such as boric acid for relief.

Known for its antifungal properties, boric acid can be a popular choice for those seeking out a holistic approach to treatment. But how does it work, and is it safe? In this article, we’ll explore what boric acid is, its role in treating BV, and important considerations for those considering this option.

What Is Boric Acid?

In the context of vaginal health, boric acid is often formulated into suppositories to help maintain a balanced pH in the vagina. It has mild antifungal, antibacterial, and antiviral properties, making it an effective treatment against certain infections, including bacterial vaginosis (BV) and yeast infections. While it is not a first-line treatment, boric acid has gained popularity for being a complementary remedy for enhancing vaginal health. However, it should only be used as directed, as misuse can lead to irritation or other complications.

Can Boric Acid be Used to Treat BV?

So what about boric acid for treatment of BV? Boric acid is a component in some household cleaners, but it is also used to help with vaginal pH. The “good” bacteria that live in the vagina prefer an acidic environment, so there is a thought that creating a more acidic environment can promote better vaginal bacterial balance. [5]

Boric acid has been used since the 1970s for treating things like yeast infections and has also been used to treat other vaginal infections such as BV. Unfortunately, studies looking at the efficacy of boric acid for the treatment of BV have not supported the use of BV as a single therapy. [6] Studies do show that boric acid may be used in combination with traditional antibiotic therapy for difficult-to-treat infections.

One study, the Boric Acid, Alternate Solution for Intravaginal Colonization (BASIC) trial, was designed to evaluate whether the results for boric acid were similar to metronidazole (traditional) therapy. [7] Preliminary results from this study show promise for this treatment, though there is not enough data for the treatment to be widely recommended. [7]

Boric Acid As a Maintenance Therapy

Boric acid may be used in some cases to help prevent recurrent bacterial vaginosis. This maintenance therapy has had some success. The studies usually require patients to undergo a treatment regimen before starting maintenance therapy. This regimen is usually boric acid suppositories vaginally two to three times weekly (generally 300-600mg). Treatment is often continued for weeks to months after starting. [6] Studies into the use of boric acid for the prevention of recurrent BV have shown high patient satisfaction and a good side effect profile. [8]

What Is BV?

BV is an overgrowth of the normal bacteria that live in the vagina leading to an infection in the vaginal tissues. [1] The vaginal bacteria fall into two types: anaerobic (non-oxygen) and aerobic (oxygen). When you read about BV, you’ll see a reference to good and bad bacteria. The bacteria themselves aren’t good or bad, but how they affect the body can vary based on their balance.

BV is not an STD despite it commonly being discussed in conjunction with sexually transmitted diseases. [2] BV is also not a yeast infection, though it shares similarities in that both are frequently related to an imbalance of the vaginal flora.

Who Is at Risk for BV?

Bacterial vaginosis is the most common vaginal infection in women and people assigned female at birth (AFAB). [1] Bacterial vaginosis may occur in up to 35% of women and people with AFAB. There are several factors that can increase your risk for BV, including [2]:

• Pregnancy
• Unprotected sex (no condoms or dental dams)
• Intrauterine device use (IUD)
• Multiple sexual partners
• New sexual partners
• Having a female (or AFAB) partner
• Douching
• Recent antibiotic use
• Use of sex toys, especially unsanitized toys

These aren’t the only risk factors for BV, but they are the most common.

What Are the Symptoms of BV?

More than 80% of people with BV have no symptoms at all. [2] If symptoms occur, they mostly commonly include [1]:

• Green, grey, or off-white vaginal discharge
• Itching, burning, or irritation of the vaginal area
• Dysuria
• Fishy odor from the vaginal area, especially after intercourse

Many symptoms of BV mimic the symptoms of other infections, such as sexually transmitted infections and yeast infections. This can make diagnosis of BV more difficult. It’s important to properly identify the cause of the infection because BV is treated differently than STDs. [3]

How Is BV Diagnosed?

Because bacterial vaginosis is similar to other infections, it can be difficult to diagnose based on history and symptoms alone, but it is possible in some cases. Commonly, confirming a diagnosis of BV is done through an exam and possibly routine lab testing.

• Pelvic Exam: Your healthcare provider may find it necessary to do a pelvic exam to look at the skin around the vagina and the vaginal mucosa. They’re looking for inflammation, discharge, and any sores or lesions. The pelvic exam may also include putting gloved fingers into the vagina to feel the uterus and ovaries for tenderness or masses.
• Whiff test: For this test, your healthcare provider may collect a sample of the fluid and smell the discharge to determine if a fish-life smell is present. [1]
• Wet Mount: This test consists of your healthcare provider collecting a sample of fluid and preparing a slide to look for clue cells, which are white blood cells with bacteria attached to the cell walls.
• Cultures: In some cases, a swab can be sent to the lab to determine the type of bacteria present in the vagina.

What Are the Complications of BV?

BV can have serious complications if it is not treated. [2]

• Endometritis or salpingitis (infections of the uterus or fallopian tubes)
• Increased risk of contracting STDs
• Increased risk of postsurgical infections
• Increased risk of pregnancy complications such as preterm labor, preterm rupture of membranes, or postpartum endometritis
• Increased risk of developing serious infections of the uterus such as pelvic inflammatory disease (PID)
• Increased risk of infections in the newborn such as neonatal meningitis

How Is BV Treated?

Because of the risk of serious complications, it is important to treat people who are pregnant regardless of whether they have symptoms. It is also important to treat non-pregnant people who have symptoms. [4] The best treatment for BV is an antibiotic prescribed by a healthcare provider. While there are over-the-counter treatments available, the best data available supports the use of antibiotics.

To that end, there are several treatments that your healthcare may consider and prescribe. These can be given either orally or vaginally. These treatments include [4] :

• Metronidazole (Flagyl) oral (500mg two times daily for seven days)
• Metronidazole vaginal gel (0.75%, 5grams vaginally daily for five days)
• Clindamycin vaginal cream (2%, 5grams vaginally for seven days)
• Clindamycin orally (300mg orally twice daily for seven days)
• Clindamycin ovules (100mg vaginally for three days)
• Secnidazole (2 grams orally in a single dose)
• Tinidazole (2 grams orally daily for two days or 1 gram orally for 5 days)

In addition to these treatments, you should also be tested for sexually transmitted infections if you have BV. This is due to the increased risk of contracting these infections if BV is present.

Manage Your Vaginal Symptoms With Everlywell

BV is one of the most common vaginal health concerns and can be recurrent and uncomfortable. Going to your regular healthcare provider takes time and can disrupt your day. If you’re concerned that you may have BV, consider Everlywell. With the bacterial vaginosis online treatment option from Everlywell, you can seek care from a licensed healthcare provider from the comfort of home. You simply fill out a form submitting your medical information and symptoms. One of our healthcare providers will review the information and provide a clinical evaluation. If appropriate, a prescription will be sent to your pharmacy.

If you’re concerned BV has put you at risk of contracting a sexually transmitted infection, Everlywell can help you there as well. You can book a virtual visit to speak with an experienced clinician to discuss your concerns. You can also get STD testing and, if needed, a provider will recommend the best course of action for online STD treatment.

1. Bacterial vaginosis. Cleveland Clinic. Published May 1, 2024.Medical Citation URL.
2. Kairys N, Carlson K, Garg M. Bacterial vaginosis. StatPearls - NCBI Bookshelf. Published May 6, 2024. Medical Citation URL.
3. About Bacterial vaginosis (BV). Centers for Disease Control and Prevention. Published December 11, 2023. Medical Citation URL.
4. Bacterial Vaginosis - STI treatment Guidelines. Centers for Disease Control and Prevention. Medical Citation URL
5. Boric Acid vaginal suppository. Cleveland Clinic. Published May 1, 2024. Medical Citation URL
6. Müller ML, Petersen CD, Saunte DML. Boric Acid for the Treatment of Vaginitis: New Possibilities Using an Old Anti‐Infective Agent: A Systematic review. Dermatologic Therapy. 2024;2024(1). doi:10.1155/2024/2807070. Medical Citation URL
7. Mullins MZ, Trouton KM. BASIC study: is intravaginal boric acid non-inferior to metronidazole in symptomatic bacterial vaginosis? Study protocol for a randomized controlled trial. Trials. 2015;16(1). doi:10.1186/s13063-015-0852-5. Medical Citation URL
8. Powell A, Ghanem KG, Rogers L, et al. Clinicians’ use of intravaginal boric acid maintenance therapy for recurrent vulvovaginal candidiasis and bacterial vaginosis. Sexually Transmitted Diseases. 2019;46(12):810-812. doi:10.1097/olq.0000000000001063. Medical Citation URL