Clinicians’ use of Intravaginal Boric Acid Maintenance Therapy for Recurrent Vulvovaginal Candidiasis and Bacterial Vaginosis Original paper
Researched by:
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Karen Pendergrass
ID
Karen Pendergrass
Karen Pendergrass is a microbiome researcher specializing in microbiome-targeted interventions (MBTIs). She systematically analyzes scientific literature to identify microbial patterns, develop hypotheses, and validate interventions. As the founder of the Microbiome Signatures Database, she bridges microbiome research with clinical practice. In 2012, based on her own investigative research, she became the first documented case of FMT for Celiac Disease—four years before the first published case study.
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Women’s Health
Women’s Health
Women’s health, a vital aspect of medical science, encompasses various conditions unique to women’s physiological makeup. Historically, women were often excluded from clinical research, leading to a gap in understanding the intricacies of women’s health needs. However, recent advancements have highlighted the significant role that the microbiome plays in these conditions, offering new insights and potential therapies. MicrobiomeSignatures.com is at the forefront of exploring the microbiome signature of each of these conditions to unravel the etiology of these diseases and develop targeted microbiome therapies.
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Bacterial Vaginosis
Bacterial Vaginosis
Bacterial vaginosis (BV) is caused by an imbalance in the vaginal microbiota, where the typically dominant Lactobacillus species are significantly reduced, leading to an overgrowth of anaerobic and facultative bacteria.
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Divine Aleru
I am a biochemist with a deep curiosity for the human microbiome and how it shapes human health, and I enjoy making microbiome science more accessible through research and writing. With 2 years experience in microbiome research, I have curated microbiome studies, analyzed microbial signatures, and now focus on interventions as a Microbiome Signatures and Interventions Research Coordinator.
Researched by:
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Karen Pendergrass
ID
Karen Pendergrass
Microbiome Signatures identifies and validates condition-specific microbiome shifts and interventions to accelerate clinical translation. Our multidisciplinary team supports clinicians, researchers, and innovators in turning microbiome science into actionable medicine.
Divine Aleru
What was Studied?
This study examined the use of intravaginal boric acid (BA) maintenance therapy in women with recurrent vulvovaginal candidiasis (rVVC) and recurrent bacterial vaginosis (rBV). The researchers performed a retrospective chart review to evaluate clinicians’ approaches to prescribing BA for these conditions, focusing on dosage, duration of use, patient satisfaction, and side effects. The study aimed to assess the effectiveness, tolerability, and satisfaction of long-term BA therapy in real-world clinical settings.
Who was Studied?
The study reviewed the medical records of 78 patients from a Johns Hopkins University-affiliated outpatient gynecology clinic. These patients were prescribed intravaginal BA for either rVVC, rBV, or both conditions. The patients were selected based on specific criteria, including multiple visits where BA usage was documented, and those who were prescribed a long-term BA regimen (more than a month). Patients were excluded if there was insufficient documentation regarding the initiation or duration of BA use.
What were the Most Important Findings?
The study revealed that maintenance therapy with intravaginal boric acid was commonly prescribed for rVVC and rBV, with an average duration of use estimated at 13.3 months. A significant portion of patients (37.2%) used BA for a year or more, with some patients continuing therapy for more than three years. The treatment regimen typically included a 7-14 day induction phase with BA, followed by a maintenance phase where patients used 300mg or 600mg of BA 2-3 times per week.
Despite the lack of long-term safety data, the study found high patient satisfaction with BA therapy (76.9%), though a small number of patients (16.7%) were dissatisfied, typically due to continued or worsening symptoms. The study also indicated that patients with rVVC were more likely to receive BA as part of an antifungal induction regimen, while patients with rBV were often prescribed antibiotics in addition to BA. Side effects were rare, with a few patients reporting vaginal irritation or leaking, but these effects were generally manageable.
What are the Implications of this Study?
This study provides real-world evidence supporting the use of intravaginal boric acid as a long-term treatment for recurrent vulvovaginal candidiasis and bacterial vaginosis. Despite the absence of large-scale prospective studies, the findings suggest that BA is well-tolerated over extended periods and that it may be an effective option for women with azole-resistant infections. This study’s insights into patient satisfaction, side effects, and clinical practice could inform future treatment guidelines and clinical trials for rVVC and rBV. However, more robust, prospective studies are needed to confirm the efficacy and long-term safety of BA maintenance therapy and to compare it with other available treatments.
Bacterial Vaginosis
Bacterial vaginosis (BV) is caused by an imbalance in the vaginal microbiota, where the typically dominant Lactobacillus species are significantly reduced, leading to an overgrowth of anaerobic and facultative bacteria.