Boric acid is an

antiseptic An antiseptic ( and ) is an antimicrobial substance or compound that is applied to living tissue to reduce the possibility of sepsis, infection, or putrefaction. Antiseptics are generally distinguished from ''antibiotics'' by the latter's abil ...

used as a

vaginal In mammals and other animals, the vagina (: vaginas or vaginae) is the elastic, muscular reproductive organ of the female genital tract. In humans, it extends from the vulval vestibule to the cervix (neck of the uterus). The vaginal introit ...

medication Medication (also called medicament, medicine, pharmaceutical drug, medicinal product, medicinal drug or simply drug) is a drug used to medical diagnosis, diagnose, cure, treat, or preventive medicine, prevent disease. Drug therapy (pharmaco ...

to treat

vaginal infection Vaginitis, also known as vulvovaginitis, is inflammation of the vagina and vulva. Symptoms may include itching, burning, pain, discharge, and a bad smell. Certain types of vaginitis may result in complications during pregnancy. The three mai ...

s including

yeast infection Candidiasis is a fungal infection due to any species of the genus '' Candida'' (a yeast). When it affects the mouth, in some countries it is commonly called thrush. Signs and symptoms include white patches on the tongue or other areas of the ...

bacterial vaginosis Bacterial vaginosis (BV) is an infection of the vagina caused by excessive growth of bacteria. Common symptoms include increased vaginal discharge that often smells like fish. The discharge is usually white or gray in color. Burning with urina ...

, and

trichomoniasis Trichomoniasis (trich) is an infectious disease caused by the parasite ''Trichomonas vaginalis''. About 70% of affected people do not have symptoms when infected. When symptoms occur, they typically begin 5 to 28 days after exposure. Symptoms ca ...

. It is administered as a capsule or

suppository A suppository is a dosage form used to deliver pharmaceutical drug, medications by insertion into a body orifice (any opening in the body), where it dissolves or melts to exert local or systemic effects. There are three types of suppositories, eac ...

inserted into the

vagina In mammals and other animals, the vagina (: vaginas or vaginae) is the elastic, muscular sex organ, reproductive organ of the female genital tract. In humans, it extends from the vulval vestibule to the cervix (neck of the uterus). The #Vag ...

. The compound is not a

pharmaceutical drug Medication (also called medicament, medicine, pharmaceutical drug, medicinal product, medicinal drug or simply drug) is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy ( pharmacotherapy) is an important part of the ...

and is instead available

over-the-counter Over-the-counter (OTC) drugs are medicines sold directly to a consumer without a requirement for a prescription from a healthcare professional, as opposed to prescription drugs, which may be supplied only to consumers possessing a valid pres ...

. Boric acid has shown comparable effectiveness to

antifungal An antifungal medication, also known as an antimycotic medication, is a pharmaceutical fungicide or fungistatic used to treat and prevent mycosis such as athlete's foot, ringworm, candidiasis (thrush), serious systemic infections such as ...

s in the treatment of vaginal yeast infections. Clinical data for other vaginal infections are more limited.

Side effect In medicine, a side effect is an effect of the use of a medicinal drug or other treatment, usually adverse but sometimes beneficial, that is unintended. Herbal and traditional medicines also have side effects. A drug or procedure usually use ...

s of vaginal boric acid may include watery discharge,

burning Combustion, or burning, is a high-temperature exothermic redox chemical reaction between a fuel (the reductant) and an oxidant, usually atmospheric oxygen, that produces oxidized, often gaseous products, in a mixture termed as smoke. Combust ...

itching An itch (also known as pruritus) is a sensation that causes a strong desire or reflex to scratch. Itches have resisted many attempts to be classified as any one type of sensory experience. Itches have many similarities to pain, and while both ...

, redness,

bleeding Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethr ...

, and erosive changes. They are usually mild and temporary. Boric acid can produce

toxic Toxicity is the degree to which a chemical substance or a particular mixture of substances can damage an organism. Toxicity can refer to the effect on a whole organism, such as an animal, bacterium, or plant, as well as the effect on a subst ...

effects, including

death Death is the end of life; the irreversible cessation of all biological functions that sustain a living organism. Death eventually and inevitably occurs in all organisms. The remains of a former organism normally begin to decompose sh ...

, if taken

orally The word oral may refer to: Relating to the mouth * Relating to the mouth, the first portion of the alimentary canal that primarily receives food and liquid **Oral administration of medicines ** Oral examination (also known as an oral exam or oral ...

and/or at very high doses. The exact

mechanism of action In pharmacology, the term mechanism of action (MOA) refers to the specific biochemical Drug interaction, interaction through which a Medication, drug substance produces its pharmacological effect. A mechanism of action usually includes mention o ...

of boric acid as an antiseptic is unclear.

Chemically A chemical reaction is a process that leads to the chemical transformation of one set of chemical substances to another. When chemical reactions occur, the atoms are rearranged and the reaction is accompanied by an energy change as new products ...

, boric acid is a boron compound, or a compound containing the

element Element or elements may refer to: Science * Chemical element, a pure substance of one type of atom * Heating element, a device that generates heat by electrical resistance * Orbital elements, parameters required to identify a specific orbit of o ...

boron Boron is a chemical element; it has symbol B and atomic number 5. In its crystalline form it is a brittle, dark, lustrous metalloid; in its amorphous form it is a brown powder. As the lightest element of the boron group it has three ...

, and is also known as trihydroxyboron. Boric acid has been used medically since ancient times, but its discovery as a

chemical compound A chemical compound is a chemical substance composed of many identical molecules (or molecular entities) containing atoms from more than one chemical element held together by chemical bonds. A molecule consisting of atoms of only one element ...

was not until the 1600s. Its antiseptic properties were reported around 1875. The compound was being used as a vaginal antiseptic by the late 1800s. Clinical studies of boric acid for treatment of vaginal infections began being published in the late 1900s and early 2000s. Despite not being a pharmaceutical drug, boric acid is widely used by women in the management of vaginal infections. It may be difficult to obtain in some countries.

Medical uses

Boric acid is used to treat

vulvovaginal candidiasis Vaginal yeast infection, also known as candidal vulvovaginitis and vaginal thrush, is excessive growth of yeast in the vagina that results in irritation. The most common symptom is vaginal itching, which may be severe. Other symptoms include burn ...

(VVC). It has been found to be similarly effective to

azole Azoles are a class of five-membered heterocyclic compounds containing a nitrogen atom and at least one other non-carbon atom (i.e. nitrogen, sulfur, or oxygen) as part of the ring. Their names originate from the Hantzsch–Widman nomenclature. Th ...

s like

fluconazole Fluconazole is an antifungal medication used for a number of fungal infections. These include candidiasis, blastomycosis, coccidioidomycosis, cryptococcosis, histoplasmosis, dermatophytosis, and tinea versicolor. It is also used to pr ...

and

itraconazole Itraconazole, sometimes abbreviated ITZ, is an antifungal medication used to treat a number of fungal infections. This includes aspergillosis, blastomycosis, coccidioidomycosis, histoplasmosis, and paracoccidioidomycosis. It may be given ...

in the treatment of vaginal ''

Candida glabrata ''Nakaseomyces glabratus'' is a species of haploid yeast of the genus ''Nakaseomyces'', previously known as ''Candida glabrata''. Despite the fact that no sexual life cycle has been documented for this species, ''N. glabratus'' strains of both ma ...

'' infections. The average cure rate of boric acid against vulvovaginal candidiasis has been found to be 76% (range 40–100%), whereas the average cure rate with antifungal medications was 61% (range 25–100%). For non-''

Candida albicans ''Candida albicans'' is an opportunistic pathogenic yeast that is a common member of the human gut flora. It can also survive outside the human body. It is detected in the gastrointestinal tract and mouth in 40–60% of healthy adults. It is usu ...

'' vulvovaginal candidiasis specifically, the cure rate was 72% (range 40–100%) for boric acid versus ~55% (range 25–100%) for azole antifungals. Boric acid is also used to treat recurrent vulvovaginal candidiasis, for instance as a maintenance therapy. It has been found to be equally effective to

oral The word oral may refer to: Relating to the mouth * Relating to the mouth, the first portion of the alimentary canal that primarily receives food and liquid **Oral administration of medicines ** Oral examination (also known as an oral exam or ora ...

for this purpose. The compound is one the only options available for treatment of azole-resistant vulvovaginal candidiasis and is considered a

first-line therapy A therapy or medical treatment is the attempted remediation of a health problem, usually following a medical diagnosis. Both words, ''treatment'' and ''therapy'', are often abbreviated tx, Tx, or Tx. As a rule, each therapy has indications an ...

in this context. Boric acid is recommended at a dose of 600mg vaginally once per day for 2 to 3weeks for acute or recurrent vulvovaginal candidiasis. It has also been used at a continuous maintenance dosage of 600mg twice weekly for recurrent vulvovaginal candidiasis suppression. The drug is used to treat

(BV). It is specifically used following treatment with or in combination with

nitroimidazole Nitroimidazoles are the group of organic compound, organic compounds consisting of an imidazole ring with at least one nitro group substituent. The term also refers to the class of antibiotics that have nitroimidazole in their structures. These an ...

s like

metronidazole Metronidazole, sold under the brand name Flagyl and Metrogyl among others, is an antibiotic and antiprotozoal medication. It is used either alone or with other antibiotics to treat pelvic inflammatory disease, endocarditis, and bacterial vagino ...

for recurrent bacterial vaginosis. Although it has been reported to be effective and is widely used for this purpose, clinical studies of boric acid for treatment of bacterial vaginosis are few and evidence is very limited. Based on unpublished data, boric acid by itself has been reported to be inadequate in the initial treatment of acute bacterial vaginosis and is not recommended for this purpose. The compound has also been used to treat recurrent bacterial vaginosis as a maintenance or suppressive therapy. It is recommended at a dose of 600mg/day for 2 to 3weeks for treatment of acute recurrent bacterial vaginosis. It is also suggested at a continuous maintenance dosage of 600mg two to three times weekly for resistant or recurrent bacterial vaginosis suppression. Boric acid has been reported to be effective in the treatment of resistant

. Eleven

case report In medicine, a case report is a detailed report of the symptoms, signs, diagnosis, treatment, and follow-up of an individual patient. Case reports may contain a demographic profile of the patient, but usually describe an unusual or novel occurrenc ...

s of boric acid for trichomoniasis have been published. The compound was reported to be effective in some but not all of these cases. Of six cases of boric acid monotherapy for recurrent trichomoniasis, three (50%) were cured after prolonged treatment. Effective treatment may require high doses of boric acid for multiple months, for instance 600mg twice daily for 2months. Boric acid has also been used in combination with other agents such as metronidazole to treat trichomoniasis. It may be a particularly applicable option in women with trichomoniasis who have nitroimidazole

intolerance Intolerance may refer to: * Hypersensitivity or intolerance, undesirable reactions produced by the immune system * ''Intolerance'' (film), a 1916 film by D. W. Griffith * ''Intolerance'' (album), the first solo album from Grant Hart, formerly ...

or resistance. Boric acid may be useful in the treatment of vulvovaginal

trichosporonosis Trichosporonosis is a systemic disease associated with fungi in the genus '' Trichosporon''. It can appear in patients who are immunosuppressed. Vaginal boric acid may be useful in the treatment of vagina In mammals and other animals ...

as well. Boric acid for continuous maintenance therapy of trichomoniasis has not been studied. Vaginal boric acid may be useful in treating

dysbiosis Dysbiosis (also called dysbacteriosis) is characterized by a disruption to the microbiome resulting in an imbalance in the microbiota, changes in their functional composition and metabolic activities, or a shift in their local distribution. For e ...

and malodorous discharge in those with

neovagina Vaginoplasty is any surgical procedure that results in the construction or reconstruction of the vagina. It is a type of genitoplasty. Pelvic organ prolapse is often treated with one or more surgeries to repair the vagina. Sometimes a vaginoplas ...

s, for instance

transgender women A trans woman or transgender woman is a woman who was assigned male at birth. Trans women have a female gender identity and may experience gender dysphoria (distress brought upon by the discrepancy between a person's gender identity and their ...

. However, little evidence is available and more research is needed in this area. Boric acid has been recommended for treatment of vaginal infections by multiple

medical guideline A medical guideline (also called a clinical guideline, standard treatment guideline, or clinical practice guideline) is a document with the aim of guiding decisions and criteria regarding diagnosis, management, and treatment in specific areas of ...

Available forms

Boric acid is usually used in the form of a

gelatin Gelatin or gelatine () is a translucent, colorless, flavorless food ingredient, commonly derived from collagen taken from animal body parts. It is brittle when dry and rubbery when moist. It may also be referred to as hydrolyzed collagen, coll ...

vegetable Vegetables are edible parts of plants that are consumed by humans or other animals as food. This original meaning is still commonly used, and is applied to plants collectively to refer to all edible plant matter, including edible flower, flo ...

-based capsule containing 600mg of boric acid powder. It may be difficult to obtain in some countries.

Contraindications

It is recommended that vaginal boric acid be avoided in

pregnant Pregnancy is the time during which one or more offspring gestation, gestates inside a woman's uterus. A multiple birth, multiple pregnancy involves more than one offspring, such as with twins. Conception (biology), Conception usually occurs ...

and

lactating Lactation describes the secretion of milk from the mammary glands and the period of time that a mother lactates to feed her young. The process naturally occurs with all sexually mature female mammals, although it may predate mammals. The proces ...

women. It is teratogenic at sufficient doses in animals.

Side effects

The most common

adverse effect An adverse effect is an undesired harmful effect resulting from a medication or other intervention, such as surgery. An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. The term compli ...

of vaginal boric acid has been found to be temporary vaginal

(5%). Other

side effect In medicine, a side effect is an effect of the use of a medicinal drug or other treatment, usually adverse but sometimes beneficial, that is unintended. Herbal and traditional medicines also have side effects. A drug or procedure usually use ...

s of vaginal boric acid have been found to include

irritation Irritation, in biology and physiology, is a state of inflammation or painful reaction to allergy or cell-lining damage. A stimulus or agent which induces the state of irritation is an irritant. Irritants are typically thought of as chemical age ...

, redness,

, and erosive changes in a small percentage of women (2.3%). Watery discharge appears to be a common and mild adverse effect of vaginal boric acid, but its frequency is unknown. Another reported side effect is a gritty sensation with

sexual intercourse Sexual intercourse (also coitus or copulation) is a sexual activity typically involving the insertion of the Erection, erect male Human penis, penis inside the female vagina and followed by Pelvic thrust, thrusting motions for sexual pleasure ...

during treatment. The side effects of vaginal boric acid are usually mild and temporary. The

safety Safety is the state of being protected from harm or other danger. Safety can also refer to the control of recognized hazards in order to achieve an acceptable level of risk. Meanings The word 'safety' entered the English language in the 1 ...

topical A topical medication is a medication that is applied to a particular place on or in the body. Most often topical medication means application to body surfaces such as the skin or mucous membranes to treat ailments via a large range of classes ...

boric acid, including its long-term safety, is under-characterized. Boric acid has known

properties when taken

or at high doses. It is also a widely used

pesticide Pesticides are substances that are used to control pests. They include herbicides, insecticides, nematicides, fungicides, and many others (see table). The most common of these are herbicides, which account for approximately 50% of all p ...

. However, vaginal boric acid appears to be safe based on available data. No reports of serious toxicity with vaginal boric acid have been published since the 1880s, when extremely high doses (25 to 100times higher than present recommended doses) were employed. Since the 1880s, only sporadic and mild side effects have been documented. This has included findings in more than 2,000women in one study. Nonetheless, it is possible that rare but serious side effects could exist. Boric acid may be able to cause local tissue injury due to

caustic Caustic most commonly refers to: * Causticity, the property of being able to corrode organic tissue ** Sodium hydroxide, sometimes called ''caustic soda'' ** Potassium hydroxide, sometimes called ''caustic potash'' ** Calcium oxide, sometimes cal ...

effects.

Overdose

Symptoms of boric acid poisoning, for instance with large amounts of orally ingested boric acid, may include

nausea Nausea is a diffuse sensation of unease and discomfort, sometimes perceived as an urge to vomit. It can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest, abdomen, or back of the throat. Over 30 d ...

vomiting Vomiting (also known as emesis, puking and throwing up) is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Vomiting can be the result of ailments like food poisoning, gastroenteritis, pre ...

abdominal pain Abdominal pain, also known as a stomach ache, is a symptom associated with both non-serious and serious medical issues. Since the abdomen contains most of the body's vital organs, it can be an indicator of a wide variety of diseases. Given th ...

, and

diarrhea Diarrhea (American English), also spelled diarrhoea or diarrhœa (British English), is the condition of having at least three loose, liquid, or watery bowel movements in a day. It often lasts for a few days and can result in dehydration d ...

. More severe symptoms may include blue-green vomit,

central nervous system depression Central nervous system depression (or CNS depression) is a nervous system disorder characterized by a severely impaired physiological state in which patients may exhibit decreased rate of breathing, decreased heart rate, and loss of consciousnes ...

fever Fever or pyrexia in humans is a symptom of an anti-infection defense mechanism that appears with Human body temperature, body temperature exceeding the normal range caused by an increase in the body's temperature Human body temperature#Fever, s ...

headache A headache, also known as cephalalgia, is the symptom of pain in the face, head, or neck. It can occur as a migraine, tension-type headache, or cluster headache. There is an increased risk of Depression (mood), depression in those with severe ...

dermatitis Dermatitis is a term used for different types of skin inflammation, typically characterized by itchiness, redness and a rash. In cases of short duration, there may be small blisters, while in long-term cases the skin may become thickened ...

or skin eruptions, a "boiled lobster"

skin rash A rash is a change of the skin that affects its color, appearance, or texture. A rash may be localized in one part of the body, or affect all the skin. Rashes may cause the skin to change color, itch, become warm, bumpy, chapped, dry, cracked ...

, reversible

scalp hair loss Pattern hair loss (also known as androgenetic alopecia (AGA)) is a hair loss condition that primarily affects the top and front of the scalp. In male-pattern hair loss (MPHL), the hair loss typically presents itself as either a receding front h ...

weakness Weakness is a symptom of many different medical conditions. The causes are many and can be divided into conditions that have true or perceived muscle weakness. True muscle weakness is a primary symptom of a variety of skeletal muscle diseases, ...

cyanosis Cyanosis is the change of Tissue (biology), tissue color to a bluish-purple hue, as a result of decrease in the amount of oxygen bound to the hemoglobin in the red blood cells of the capillary bed. Cyanosis is apparent usually in the Tissue (bi ...

, and

kidney failure Kidney failure, also known as renal failure or end-stage renal disease (ESRD), is a medical condition in which the kidneys can no longer adequately filter waste products from the blood, functioning at less than 15% of normal levels. Kidney fa ...

. However, most cases of oral boric acid overdose are

asymptomatic Asymptomatic (or clinically silent) is an adjective categorising the medical conditions (i.e., injuries or diseases) that patients carry but without experiencing their symptoms, despite an explicit diagnosis (e.g., a positive medical test). P ...

. Doses of 15 to 20grams (0.1–0.5mg/kg) have been said to be potentially fatal in adults, but findings are inconsistent and there have been cases of individuals consuming 89grams without death or severe symptoms. The doses of oral boric acid required for adverse effects appear to be much greater than a single 600mg oral dose. Toxicity of boric acid has also been reported with large amounts applied topically to the skin. The

median lethal dose In toxicology, the median lethal dose, LD50 (abbreviation for " lethal dose, 50%"), LC50 (lethal concentration, 50%) or LCt50 is a toxic unit that measures the lethal dose of a given substance. The value of LD50 for a substance is the dose re ...

s (LD₅₀) of boric acid in animals have been described. They have been found to be 2.7 to 4g/kg orally in rats and 1.8 to 2.1g/kg via

intravenous Intravenous therapy (abbreviated as IV therapy) is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutr ...

subcutaneous injection Subcutaneous administration is the insertion of medications beneath the skin either by injection or infusion. A subcutaneous injection is administered as a bolus (medicine), bolus into the subcutis, the layer of skin directly below the dermis and ...

in mice.

Interactions

Vaginal boric acid is thought to have a low risk of interactions with systemic

drug A drug is any chemical substance other than a nutrient or an essential dietary ingredient, which, when administered to a living organism, produces a biological effect. Consumption of drugs can be via insufflation (medicine), inhalation, drug i ...

Pharmacology

Pharmacodynamics

Boric acid is an

and has

bacteriostatic A bacteriostatic agent or bacteriostat, abbreviated Bstatic, is a biological or chemical agent that stops bacteria from reproducing, while not necessarily killing them otherwise. Depending on their application, bacteriostatic antibiotics, disinfec ...

and fungistatic effects. It has often been described as a weak or mild

antimicrobial An antimicrobial is an agent that kills microorganisms (microbicide) or stops their growth (bacteriostatic agent). Antimicrobial medicines can be grouped according to the microorganisms they are used to treat. For example, antibiotics are used aga ...

. The compound is not an

antibiotic An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting pathogenic bacteria, bacterial infections, and antibiotic medications are widely used in the therapy ...

, and in contrast to these agents, has

broad-spectrum A broad-spectrum antibiotic is an antibiotic that acts on the two major bacterial groups, Gram-positive and Gram-negative, or any antibiotic that acts against a wide range of disease-causing bacteria. These medications are used when a bacterial in ...

antimicrobial activity and inhibits multiple different biological processes of

microorganism A microorganism, or microbe, is an organism of microscopic scale, microscopic size, which may exist in its unicellular organism, single-celled form or as a Colony (biology)#Microbial colonies, colony of cells. The possible existence of unseen ...

s. As a result,

antimicrobial resistance Antimicrobial resistance (AMR or AR) occurs when microbes evolve mechanisms that protect them from antimicrobials, which are drugs used to treat infections. This resistance affects all classes of microbes, including bacteria (antibiotic resista ...

is less likely to develop to boric acid. It has been reported to specifically be active against the

gram-positive In bacteriology, gram-positive bacteria are bacteria that give a positive result in the Gram stain test, which is traditionally used to quickly classify bacteria into two broad categories according to their type of cell wall. The Gram stain is ...

and

gram-negative Gram-negative bacteria are bacteria that, unlike gram-positive bacteria, do not retain the crystal violet stain used in the Gram staining method of bacterial differentiation. Their defining characteristic is that their cell envelope consists ...

bacteria Bacteria (; : bacterium) are ubiquitous, mostly free-living organisms often consisting of one Cell (biology), biological cell. They constitute a large domain (biology), domain of Prokaryote, prokaryotic microorganisms. Typically a few micr ...

, bacteria like

staphylococci ''Staphylococcus'', from Ancient Greek σταφυλή (''staphulḗ''), meaning "bunch of grapes", and (''kókkos''), meaning "kernel" or " Kermes", is a genus of Gram-positive bacteria in the family Staphylococcaceae from the order Bacillale ...

and

streptococci ''Streptococcus'' is a genus of gram-positive spherical bacteria that belongs to the family Streptococcaceae, within the order Lactobacillales (lactic acid bacteria), in the phylum Bacillota. Cell division in streptococci occurs along a sing ...

, and the

fungi A fungus (: fungi , , , or ; or funguses) is any member of the group of eukaryotic organisms that includes microorganisms such as yeasts and mold (fungus), molds, as well as the more familiar mushrooms. These organisms are classified as one ...

'' Candida spp.'' (including ''

'' and ''

'') and ''

Saccharomyces cerevisiae ''Saccharomyces cerevisiae'' () (brewer's yeast or baker's yeast) is a species of yeast (single-celled fungal microorganisms). The species has been instrumental in winemaking, baking, and brewing since ancient times. It is believed to have be ...

'', among others. It has been said to not be active against all

pathogen In biology, a pathogen (, "suffering", "passion" and , "producer of"), in the oldest and broadest sense, is any organism or agent that can produce disease. A pathogen may also be referred to as an infectious agent, or simply a Germ theory of d ...

s, for instance mold fungus. The exact

of boric acid is unclear. One hypothesis is that boric acid works via vaginal

acidification Acidification may refer to: * Ocean acidification, decrease in the pH of the Earth's oceans * Freshwater acidification, atmospheric depositions and soil leaching of SOx and NOx * Soil acidification, buildup of hydrogen cations, which reduces the ...

, raising vaginal pH and thereby creating and environment less hospitable to undesirable microorganisms. However, in studies, its

properties have been found to be independent of pH. Boric acid can also inhibit bacterial and fungal

biofilm A biofilm is a Syntrophy, syntrophic Microbial consortium, community of microorganisms in which cell (biology), cells cell adhesion, stick to each other and often also to a surface. These adherent cells become embedded within a slimy ext ...

s. However, it may not be effective against pre-existing biofilms.

Pharmacokinetics

Boric acid for vaginal infections is indicated for

vaginal administration Intravaginal administration is a route of administration where the substance is applied inside the vagina. Pharmacologically, it has the potential advantage to result in effects primarily in the vagina or nearby structures (such as the vaginal p ...

and not for

oral administration Oral administration is a route of administration whereby a substance is taken through the Human mouth, mouth, swallowed, and then processed via the digestive system. This is a common route of administration for many medications. Oral administ ...

. Oral administration of boric acid can result in serious

toxicity Toxicity is the degree to which a chemical substance or a particular mixture of substances can damage an organism. Toxicity can refer to the effect on a whole organism, such as an animal, bacteria, bacterium, or plant, as well as the effect o ...

Absorption

Boric acid rapidly and completely absorbed from the

gastrointestinal tract The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the tract or passageway of the Digestion, digestive system that leads from the mouth to the anus. The tract is the largest of the body's systems, after the cardiovascula ...

with oral administration. Its oral

bioavailability In pharmacology, bioavailability is a subcategory of absorption and is the fraction (%) of an administered drug that reaches the systemic circulation. By definition, when a medication is administered intravenously, its bioavailability is 100%. H ...

appears to be almost 100%. Absorption of boric acid through intact

skin Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation. Other animal coverings, such as the arthropod exoskeleton, have different ...

appears to be minimal. However, application of boric acid to damaged skin can allow for much greater absorption. In one study, circulating boron levels prior to treatment were undetectable (<0.04μg/mL), and following 600–1,200mg/day vaginal boric acid for 1 to 2weeks, boron levels increased to 0.42μg/mL. For comparison, normal circulating boron levels are 0.1 to 80μg/mL, acute boric acid toxicity has been associated with levels of 5.4 to 1,000μg/mL, concentrations of 80 to 126μg/mL have been observed without toxicity symptoms or signs, and boric acid levels of less than 200μg/mL are thought to be safe by many researchers. Based on a case study of one healthy woman in the study, who had boron levels of 0.1 to 0.15μg/mL, it was estimated that 6% of vaginally administered boric acid is absorbed systemically. Other studies have found undetectable boric acid levels with vaginal boric acid, though the detection threshold may not have been sensitive enough or was not reported at all.

Distribution

Following absorption, boric acid is widely

distributed Distribution may refer to: Mathematics *Distribution (mathematics), generalized functions used to formulate solutions of partial differential equations *Probability distribution, the probability of a particular value or value range of a varia ...

throughout the body. It has shown accumulation in the

brain The brain is an organ (biology), organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. It consists of nervous tissue and is typically located in the head (cephalization), usually near organs for ...

liver The liver is a major metabolic organ (anatomy), organ exclusively found in vertebrates, which performs many essential biological Function (biology), functions such as detoxification of the organism, and the Protein biosynthesis, synthesis of var ...

, and

kidney In humans, the kidneys are two reddish-brown bean-shaped blood-filtering organ (anatomy), organs that are a multilobar, multipapillary form of mammalian kidneys, usually without signs of external lobulation. They are located on the left and rig ...

s. Its

volume of distribution In pharmacology, the volume of distribution (VD, also known as apparent volume of distribution, literally, ''volume of dilution'') is the theoretical volume that would be necessary to contain the total amount of an administered drug at the same c ...

is 0.17 to 0.5L/kg in humans. The

plasma protein binding Plasma protein binding refers to the degree to which medications attach to blood proteins within the blood plasma. A drug's efficacy may be affected by the degree to which it binds. The less bound a drug is, the more efficiently it can traverse o ...

of boric does not appear to have been reported and hence is unknown.

Metabolism

Boric acid does not undergo appreciable

metabolism Metabolism (, from ''metabolē'', "change") is the set of life-sustaining chemical reactions in organisms. The three main functions of metabolism are: the conversion of the energy in food to energy available to run cellular processes; the co ...

. No

metabolite In biochemistry, a metabolite is an intermediate or end product of metabolism. The term is usually used for small molecules. Metabolites have various functions, including fuel, structure, signaling, stimulatory and inhibitory effects on enzymes, c ...

s of boric acid are known.

Elimination

Boric acid is rapidly and primarily eliminated in

urine Urine is a liquid by-product of metabolism in humans and many other animals. In placental mammals, urine flows from the Kidney (vertebrates), kidneys through the ureters to the urinary bladder and exits the urethra through the penile meatus (mal ...

. It is excreted 50% in urine within 12hours and 90% in urine within 4days. Small amounts of boric acid are

excreted Excretion is elimination of metabolic waste, which is an essential process in all organisms. In vertebrates, this is primarily carried out by the lungs, kidneys, and skin. This is in contrast with secretion, where the substance may have specific ...

feces Feces (also known as faeces American and British English spelling differences#ae and oe, or fæces; : faex) are the solid or semi-solid remains of food that was not digested in the small intestine, and has been broken down by bacteria in the ...

sweat Perspiration, also known as sweat, is the fluid secreted by sweat glands in the skin of mammals. Two types of sweat glands can be found in humans: eccrine glands and Apocrine sweat gland, apocrine glands. The eccrine sweat glands are distribu ...

, and

saliva Saliva (commonly referred as spit or drool) is an extracellular fluid produced and secreted by salivary glands in the mouth. In humans, saliva is around 99% water, plus electrolytes, mucus, white blood cells, epithelial cells (from which ...

. Following

intravenous injection Intravenous therapy (abbreviated as IV therapy) is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutr ...

of 600mg boric acid in healthy men, the

elimination half-life Biological half-life (elimination half-life, pharmacological half-life) is the time taken for concentration of a biological substance (such as a medication) to decrease from its maximum concentration ( Cmax) to half of Cmax in the blood plasma. ...

was found to be 21hours. On the basis of one woman in a study, the elimination half-life of boric acid with vaginal administration has been found to be 10.5hours. In cases of human poisoning, the elimination half-life of boric acid was 13 to 24hours.

Chemistry

Boric acid is usually in the form of white

crystal A crystal or crystalline solid is a solid material whose constituents (such as atoms, molecules, or ions) are arranged in a highly ordered microscopic structure, forming a crystal lattice that extends in all directions. In addition, macros ...

s, scales, or a white

powder A powder is a dry solid composed of many very fine particles that may flow freely when shaken or tilted. Powders are a special sub-class of granular materials, although the terms ''powder'' and ''granular'' are sometimes used to distinguish se ...

. It is colorless, odorless, non-irritating, and does not stain. The compound is a weak

acid An acid is a molecule or ion capable of either donating a proton (i.e. Hydron, hydrogen cation, H+), known as a Brønsted–Lowry acid–base theory, Brønsted–Lowry acid, or forming a covalent bond with an electron pair, known as a Lewis ...

. The

alkali In chemistry, an alkali (; from the Arabic word , ) is a basic salt of an alkali metal or an alkaline earth metal. An alkali can also be defined as a base that dissolves in water. A solution of a soluble base has a pH greater than 7.0. The a ...

salt In common usage, salt is a mineral composed primarily of sodium chloride (NaCl). When used in food, especially in granulated form, it is more formally called table salt. In the form of a natural crystalline mineral, salt is also known as r ...

s of boric acid are

alkaline In chemistry, an alkali (; from the Arabic word , ) is a basic salt of an alkali metal or an alkaline earth metal. An alkali can also be defined as a base that dissolves in water. A solution of a soluble base has a pH greater than 7.0. The ...

History

Boric acid has been used medically since ancient times. Its discovery in modern times is attributed to the

German German(s) may refer to: * Germany, the country of the Germans and German things **Germania (Roman era) * Germans, citizens of Germany, people of German ancestry, or native speakers of the German language ** For citizenship in Germany, see also Ge ...

chemist A chemist (from Greek ''chēm(ía)'' alchemy; replacing ''chymist'' from Medieval Latin ''alchemist'') is a graduated scientist trained in the study of chemistry, or an officially enrolled student in the field. Chemists study the composition of ...

Johann Joachim Becher Johann Joachim Becher (; 6 May 1635 – October 1682) was a German physician, alchemist, precursor of chemistry, scholar, polymath and adventurer, best known for his ''terra pinguis'' theory which became the phlogiston theory of combustion, and hi ...

in the 1600s. The compound was first prepared, from

borax The BORAX Experiments were a series of safety experiments on boiling water nuclear reactors conducted by Argonne National Laboratory in the 1950s and 1960s at the National Reactor Testing Station in eastern Idaho.

, by the

Dutch Dutch or Nederlands commonly refers to: * Something of, from, or related to the Netherlands ** Dutch people as an ethnic group () ** Dutch nationality law, history and regulations of Dutch citizenship () ** Dutch language () * In specific terms, i ...

chemist William Homberg in 1702, and he is often incorrectly said to be the discoverer of boric acid. He marketed it for medical use under the brand name "Homberg's sedative salt" and it was claimed to have

sedative A sedative or tranquilliser is a substance that induces sedation by reducing irritability or Psychomotor agitation, excitement. They are central nervous system (CNS) Depressant, depressants and interact with brain activity, causing its decelera ...

anodyne An anodyne is a drug used to lessen pain through reducing the sensitivity of the brain or nervous system. The term was common in medicine before the 20th century, but such drugs are now more often known as analgesics or painkillers. The term ' ...

(

analgesic An analgesic drug, also called simply an analgesic, antalgic, pain reliever, or painkiller, is any member of the group of drugs used for pain management. Analgesics are conceptually distinct from anesthetics, which temporarily reduce, and in s ...

), and

antispasmodic An antispasmodic (synonym: spasmolytic) is a pharmaceutical drug or other agent that suppresses muscle spasms. Smooth muscle spasm One type of antispasmodics is used for smooth muscle relaxation, especially in tubular organs of the gastrointestina ...

effects. Boric acid was first used as an

Sweden Sweden, formally the Kingdom of Sweden, is a Nordic countries, Nordic country located on the Scandinavian Peninsula in Northern Europe. It borders Norway to the west and north, and Finland to the east. At , Sweden is the largest Nordic count ...

under the brand names ''Aseptin'' (a powder) and ''Aseptin Amykos'' (a liquid) and its antiseptic properties were reported and confirmed by

British British may refer to: Peoples, culture, and language * British people, nationals or natives of the United Kingdom, British Overseas Territories and Crown Dependencies. * British national identity, the characteristics of British people and culture ...

surgeon In medicine, a surgeon is a medical doctor who performs surgery. Even though there are different traditions in different times and places, a modern surgeon is a licensed physician and received the same medical training as physicians before spec ...

and

scientist A scientist is a person who Scientific method, researches to advance knowledge in an Branches of science, area of the natural sciences. In classical antiquity, there was no real ancient analog of a modern scientist. Instead, philosophers engag ...

Joseph Lister Joseph Lister, 1st Baron Lister, (5 April 1827 – 10 February 1912) was a British surgeon, medical scientist, experimental pathologist and pioneer of aseptic, antiseptic surgery and preventive healthcare. Joseph Lister revolutionised the Sur ...

in 1874 and 1875.Nesbit, R. M. (1945). The clinical use of boric acid. Surgery, Gynecology, & Obstetrics, ''80''(6), 651–652. https://scholar.google.com/scholar?cluster=1879606307012988618 Subsequently, it became widely used for

topical application A topical medication is a medication that is applied to a particular place on or in the body. Most often topical medication means application to body surfaces such as the skin or mucous membranes to treat ailments via a large range of classes ...

for its antiseptic properties. It was first used as an intravaginal antiseptic by the late 1800s. The compound was originally thought to be benign and non-toxic, but the

of boric acid became more well-known with the publication of serious

s in 1899. The first

clinical study Clinical trials are prospective biomedical or behavioral research studies on human subject research, human participants designed to answer specific questions about biomedical or behavioral interventions, including new treatments (such as novel v ...

of boric acid for treatment of

was published in 1974. Use of boric acid for treatment of '' Torulopsis glabrata''

vaginitis Vaginitis, also known as vulvovaginitis, is inflammation of the vagina and vulva. Symptoms may include itching, burning, pain, discharge, and a bad smell. Certain types of vaginitis may result in complications during pregnancy. The three mai ...

was first reported by 1990. A

phase 2 Michael Lawrence Marrow (August 2, 1955 – December 12, 2019), known as PHASE 2 and Lonny Wood, was an American aerosol paint artist based in New York City. Mostly active in the 1970s, Phase 2 is generally credited with originating the "bubble ...

/ 3

clinical trial Clinical trials are prospective biomedical or behavioral research studies on human subject research, human participants designed to answer specific questions about biomedical or behavioral interventions, including new treatments (such as novel v ...

of boric acid versus

, the Boric Acid, Alternate Solution for Intravaginal Colonization (BASIC) study, was registered in 2014 and was completed in 2016, but the results do not appear to have been published. Clinical studies of boric acid for bacterial vaginosis have been published, but no clinical trials have been published as of 2015.

Society and culture

Names

''Boric acid'' is the generic name of the compound and its . It does not appear to have an , , , or . Boric acid has also been known as ''boracic acid'' or as ''orthoboric acid''.

Availability

Boric acid is widely available

. The availability of unregulated over-the-counter boric acid has been argued against due to

concerns. Some have proposed that boric acid should only be prescribed by a medical professional.

Research

combination In mathematics, a combination is a selection of items from a set that has distinct members, such that the order of selection does not matter (unlike permutations). For example, given three fruits, say an apple, an orange and a pear, there are ...

of boric acid and the penetration enhancer

ethylenediaminetetraacetic acid Ethylenediaminetetraacetic acid (EDTA), also called EDTA acid, is an aminopolycarboxylic acid with the formula . This white, slightly water-soluble solid is widely used to bind to iron (Fe2+/Fe3+) and calcium ions (Ca2+), forming water-solubl ...

(EDTA) is being developed under the developmental code name TOL-463 for treatment of

and

. Following treatment for 7days, it has been found to cure vulvovaginal candidiasis at rates of 92% as an

insert An SQL INSERT statement adds one or more records to any single table in a relational database. Basic form Insert statements have the following form: The number of columns and values must be the same. If a column is not specified, the default va ...

and 81% as a gel and to cure bacterial vaginosis at rates of 59% for the insert and 50% for the gel. Although the bacterial vaginosis cure rates were lower, reported symptom resolution was high for both conditions, with rates of 69 to 93%.

Veterinary medicine

Boric acid has

effects in animals similarly to humans and can result in pet poisonings.

References

{{Gynecological anti-infectives and antiseptics Antifungals Antiprotozoal agents Antiseptics

Medical uses

Available forms

Contraindications

Side effects

Overdose

Interactions

Pharmacology

Pharmacodynamics

Pharmacokinetics

Absorption

Distribution

Metabolism

Elimination

Chemistry

History

Society and culture

Names

Availability

Research

Veterinary medicine

See also

References