Bacterial vaginosis (BV) is the most common vaginal infection seen in women between 15-44 years of age.¹ It is caused by an imbalance in the natural bacteria present in the vagina. Normally, lactobacilli (beneficial bacteria) dominate the vaginal flora, producing H202 and maintaining an acidic environment with a pH of 3.8 to 4.5. However, in bacterial vaginosis, lactobacilli decrease, and an overgrowth of harmful bacteria, such as Gardnerella vaginalis, leads to a higher pH (above 4.5).

The precise cause of the bacterial imbalance in bacterial vaginosis remains unclear. However, the following risk factors increase the risk:

1. Multiple or new sexual partners, unprotected sex.

2. Vaginal douching

3. Use of hygiene products like scented soaps, bubble baths, and antiseptic liquids

4. Hormonal contraceptives and irregular menstrual cycle

5. Presence of other vaginal infections

6. Non-breathable or tight clothing

7. Recent use of heavy antibiotics

Common symptoms:

• Thin, yellowish-white, or gray vaginal discharge.

• Strong, unpleasant fishy odor from the discharge, especially noticeable after sex.

• Itching, burning, and redness around the vaginal area.

• Pain or burning during urination.

• Discomfort or pain during sexual intercourse.

However, some women may not show symptoms and only discover the condition during a medical examination.

Treating bacterial vaginosis involves using antibiotics such as metronidazole, tinidazole, secnidazole, or clindamycin, which can be administered orally or intravaginally. However, there is a risk of antibiotic resistance with these drugs. For patients with recurrent BV, adjunctive therapies like boric acid spray or suppository and probiotic supplementation help restore healthy vaginal flora.³

Vaginal yeast infection, also known as vulvovaginal candidiasis, is caused by an overgrowth of the fungus Candida albicans. Usually, this fungus is present in small amounts in our bodies, under the control of the body’s immune system and beneficial bacteria like Lactobacillus. However, when this balance is disrupted, there is an overgrowth of this yeast resulting in the symptoms of a vaginal yeast infection.

Factors that lead to yeast overgrowth:⁴

1. Uncontrolled diabetes

2. Repeated doses of antibiotics

3. High estrogen levels from pregnancy or hormone therapy like contraceptive pills

4. Weakened immune system due to drugs like corticosteroids or HIV infection

5. Intrauterine devices

6. Lifestyle factors such as wearing tight, non-breathable clothing or using scented hygiene products.

If you are sexually active and experiencing recurring infections, consider whether your sexual partner might also have a yeast infection, as the infection can be transmitted back and forth. To prevent this, avoid sexual activity or use barrier methods like condoms until both partners are treated.

Another cause of recurrence is a complicated yeast infection. If there are frequent episodes (more than four per year), pregnancy, uncontrolled diabetes, a weakened immune system, or HIV infection, you might have a complicated infection.

For recurrent or complicated yeast infections, particularly if you have significant redness, swelling, and itching with open sores or tears, the treatment plan may include a 14-day regimen of antifungal medications, multiple doses of fluconazole, or a long-term antifungal prescription.

Boric acid is highly effective for treating vaginal yeast infections, with a cure rate of up to 100%.⁵ It works by creating an acidic environment that is inhospitable to the Candida fungus. Additionally, boric acid disrupts the fungal cell membrane and prevents the formation of biofilms and the transformation of the fungus into a more invasive form. This action stops the fungus from attaching to the vaginal wall, aiding in the elimination of the infection.

Unlike antibiotics, boric acid does not carry the risk of developing bacterial resistance, making it effective even in recurrent infections. Adding boric acid to standard antibiotic treatment can increase the success rate from 70-80% to as high as 92%.^6,7 It helps create an acidic environment, promoting the growth of beneficial lactobacilli. Additionally, boric acid can eliminate bacteria that persist within the vaginal wall after antibiotic treatment by removing bacterial biofilms and mucus, targeting bacteria that antibiotics might miss.⁷

Avoid boric acid spray if you have open wounds, sores, or ulcers in the vaginal area, as it can be toxic if absorbed through these lesions. Additionally, do not use boric acid if you are pregnant or breastfeeding. It is also not advised for children under 12 years of age. Ingesting boric acid is also toxic, so it should never be swallowed.

The boric acid vaginal spray is a reasonably safe product with minimal risk of side effects. Rare side effects include vaginal irritation or burning. If you experience severe discomfort, stop using the product and consult your healthcare provider.