Intravaginal boric acid treatment for recurrent bacterial vaginosis: short-term effects on vaginal health parameters and patient satisfaction

Abstract

Background: Recurrent bacterial vaginosis affects 15–30% of women with bacterial vaginosis, demonstrating recurrence rates exceeding 60% after conventional therapy modalities. Alternative treatments are needed when standard therapies fail. Objective: To evaluate short-term effects of intravaginal boric acid on vaginal health parameters and patient satisfaction in women with recurrent bacterial vaginosis resistant to conventional treatment. Methods: This retrospective observational study analyzed 52 women with recurrent bacterial vaginosis (≥ 3 episodes within 12 months) treated with intravaginal boric acid (600 mg daily for 14 days) between January 2022 and December 2023. All participants had documented failure or rapid recurrence following metronidazole or clindamycin therapy. Primary outcomes included Vaginal Health Index and Maturation Index. Secondary outcomes comprised validated patient-reported measures (Quality of Sexual Experience Scale, Female Sexual Distress Scale) and clinical symptoms. Assessments occurred at baseline and Day 30 (16 days post-treatment). Results: Participants (mean age 34.7 ± 6.7 years, 4.2 ± 1.3 prior episodes) demonstrated significant improvements. Nugent scores decreased from 7.8 ± 0.8 to 3.1 ± 1.0 (p < 0.001), with 88.5% achieving scores < 4. Clue cells decreased from 68.4% to 8.3% (p < 0.001). Vaginal Health Index improved from 12.1 ± 1.9 to 20.5 ± 1.5 (p < 0.001, Cohen’s d = 4.9). Quality of Sexual Experience scores increased from 13.8 ± 2.3 to 38.7 ± 3.1, while Female Sexual Distress scores decreased from 38.9 ± 5.2 to 8.4 ± 2.9 (both p < 0.001). Vaginal odor prevalence decreased from 92.3% to 1.9%. Mild adverse events occurred in 7.8% of participants, with all participants completing the 14-day treatment course. Conclusions: Intravaginal boric acid was associated with significant short-term improvements in microbiological, clinical, and patient-reported outcomes. However, the single-arm retrospective design and limited follow-up preclude definitive conclusions about treatment efficacy.