Boric Acid Suppositories for Yeast Infections, BV & Safety

Boric acid is a simple white powder, a natural form of the element boron, which turns up in rocks, soil, plants and water, and it has been used in the vagina for well over a century.12 Today it comes as 600 mg of powder in a gelatin capsule, and the CDC's treatment guidelines name it for two problems that frustrate many women: yeast infections that come back after the usual antifungals, and bacterial vaginosis (BV) that keeps returning after antibiotics.48

In lab tests, boric acid slows the growth of Candida albicans yeast, keeps it from switching into the root-like threads it uses to invade tissue, and works against strains that resist fluconazole.67 In women, its best results come against the species that resist common antifungal drugs, the infections where women most need another option.

When yeast keeps coming back, the reasons it took hold matter as much as what clears it. My Candida Cleanse Protocol starts with those causes, which usually stack two or three at a time, beginning with antibiotics and sugar.9 The free protocol lays out how to work on each one.

Did you know?

• Small amounts of boric acid go into some preserved eye drops.10

• The researchers behind the 1981 trial that compared boric acid capsules with nystatin found women accepted the capsules better than messy vaginal creams.11

• Boric acid is the most common active ingredient used against cockroaches.12

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What is boric acid?

You'll find boric acid in three very different places. At the pharmacy, it's a vaginal capsule for yeast and BV. At the hardware store, it's a dust or bait for cockroaches. And in small amounts, it's an ingredient in some preserved eye drops.21310

Borax is a different compound: sodium tetraborate decahydrate, a borate salt. Borate salts convert to boric acid in moist tissue before the body absorbs them.1 The vaginal trials here used boric acid itself. The trace amounts of boron in your diet are a separate nutrient story.

A short history of boric acid

Boric acid went into the vagina long before anyone could test it in a lab. By the 1880s, women were being treated with vaginal packs of boric acid, in amounts 25 to 100 times today's 600 mg dose.2 Modern reports began in the 1970s, and in 1981, a trial compared 600 mg capsules of boric acid with capsules of nystatin, an antifungal drug of the day, without the women or the researchers knowing who got which.211

Boric acid was first registered as a pesticide in the U.S. in 1948.1 By 2021, the CDC's treatment guidelines included it for non-albicans yeast that comes back and as part of an option for recurrent BV.48

How do boric acid suppositories work?

Candida albicans can grow as round yeast cells or switch into long threads, called hyphae, that invade tissue and build protective biofilms.76 Boric acid works on several of those steps at once. Steps two through five come from lab studies of C. albicans, and the last step is the researchers' proposed reason for adding it to BV treatment:

What is boric acid good for?

Boric acid benefits, ranked by evidence

Ranked by the strength of the human research, boric acid's benefits start with clearing stubborn yeast species, then clearing common yeast infections and clearing fluconazole-resistant yeast, followed by keeping recurrent BV away alongside antibiotics, keeping recurrent yeast away, easing BV on its own and its antifungal action in the lab.

Does boric acid work for yeast infections?

Most vaginal yeast infections respond to the azoles, the family of antifungal drugs that includes fluconazole.27 Some species and strains don't: C. glabrata often responds poorly to azoles, C. krusei is naturally resistant to fluconazole, and some strains of the common C. albicans have become resistant too.3282417 Those are the infections where boric acid has the most to offer.

Stubborn species: C. glabrata and C. krusei

The strongest test comes from New Delhi, where researchers at the All India Institute of Medical Sciences randomly assigned 112 women with diabetes and a vaginal yeast infection to 600 mg boric acid capsules in the vagina once a day for 14 days or a single 150 mg dose of fluconazole by mouth, and analyzed 111 of them. C. glabrata caused 61.3% of the infections. Among the 68 women with C. glabrata, boric acid cleared the yeast on culture in 21 of 33 (63.6%), against 10 of 35 (28.6%) with fluconazole; counting only the women who finished treatment, the figures were 72.4% and 33.3%.3 The other comparisons, including women with C. albicans, overall clearance and symptoms at day 15, weren't significantly different between the groups.

Three months later, 12 of 19 women (63.1%) cleared by boric acid and 15 of 21 (71.4%) cleared by fluconazole were still clear, a difference that wasn't significant, and most relapses involved the same species.29

Clinic records from vaginitis centers show the same pattern, often in women whose infections had already failed azole drugs. At a Detroit vaginitis clinic, where azole courses had worked less than half the time, 600 mg a day for 14 days improved or cleared symptoms in 21 of 26 episodes of C. glabrata infection (81%) and cleared the yeast on culture in 20 of 26 (77%).28 In a review of 141 women with C. glabrata cultures at two centers, 2 to 3 weeks of boric acid succeeded in 47 of 73 women with symptoms (64%) in Detroit and 27 of 38 (71%) in Beer Sheba, Israel, and 21 days worked no better than 14.15 At a Philadelphia center, it cleared C. glabrata on culture in 32 of 41 women (78%), along with all 3 women with C. tropicalis and all 3 with C. lusitaniae.16 For C. krusei, researchers who reviewed 11 women with the infection named vaginal boric acid the first treatment of choice, even with newer antifungal drugs available.24

Fluconazole-resistant C. albicans

Resistance is showing up in the common species too. At a Philadelphia referral center, 71 of 970 women with C. albicans infections (7.3%) had infections that resisted fluconazole in practice, and 58 of them were treated with vaginal boric acid. The clinic reported a clearance rate on culture of 85.7% and a symptom-resolution rate of 73.7%, and 14.3% of those cleared had yeast on culture again within 3 months. The researchers expect recurrence without maintenance boric acid, which is where the maintenance routines and root causes covered below come in.17

Boric acid vs. fluconazole and nystatin

The first controlled trial, published in 1981, compared 14 daily capsules of 600 mg boric acid with identical capsules of 100,000 units of nystatin in women with C. albicans infections, and neither the women nor the researchers knew who got what. Boric acid cleared 92% at 7 to 10 days after treatment and 72% at 30 days, against 64% and 50% with nystatin; symptoms eased about as fast with both, and no unwanted side effects turned up.11

In a randomized trial of 150 women with yeast infection symptoms in Tehran, a week of nightly boric acid powder gave similar results to fluconazole: the infection cleared in 46.7% against 37.3%, and it came back in 35% against 32%; neither difference was significant. Neither the women nor the researchers knew who got what; the fluconazole dose isn't reported.18

What the guidelines and reviews say

The CDC usually defines a recurrent yeast infection as three or more episodes with symptoms in less than a year.4 For non-albicans yeast, its 2021 guidelines recommend 7 to 14 days of an azole other than fluconazole, and if the infection comes back, 600 mg of boric acid in a gelatin capsule placed in the vagina once a day for 3 weeks, a regimen that clears both the symptoms and the yeast in about 70% of women.4 The reviews point the same way. One review of 14 studies found clearance on culture ranging from 40% to 100% with boric acid, and a 2024 review of 41 studies found an average success rate of 76% for yeast infections, without pooling the studies into one estimate because they differed so much.2021

Does boric acid help BV?

Bacterial vaginosis is a shift in the vagina's bacterial balance that often brings a thin discharge and a fishy odor, and it often returns after a course of antibiotics.3031 For women with multiple recurrences, the CDC lists an option based on limited data: an oral antibiotic, metronidazole or tinidazole, for 7 days, then 600 mg of boric acid in the vagina daily for 21 days, then a metronidazole gel twice a week for 4 to 6 months.8

That regimen grew out of clinic work in Detroit. Researchers reviewed the records of 58 women treated for 77 episodes of recurrent BV, with no comparison group. After the antibiotic and boric acid, 88% to 92% of the 60 episodes checked were clear at 7 and 12 weeks, and with the twice-weekly gel added, the share still clear was 87% at 12 weeks, 78% at 16 weeks and 65% at 28 weeks. About half had relapsed by 36 weeks, and no side effects from boric acid were seen.5

A second Detroit series took on women whose BV had failed every recommended regimen. Of 105 women, 93 could be evaluated after an oral antibiotic taken together with 30 nights of boric acid, and 92 of the 93 responded.22 On the twice-weekly gel that followed, 69.6% of the women who kept to it were free of BV at 6 months, and at 12 months almost 69% of those who reached the observation phase were still BV-free. There was no comparison group, many women were lost to follow-up, and 52 of the 105 had a positive yeast culture at some point, mostly during the months on the antibiotic gel. Boric acid itself was very well tolerated, no one stopped or interrupted it, and the researchers credit its antifungal effect with keeping yeast away early in treatment.

Used on its own, boric acid has given different results in different clinics. At an Istanbul teaching hospital, the records of 52 women with recurrent BV that had failed metronidazole or clindamycin show they used 600 mg of boric acid in the vagina at bedtime for 14 nights and nothing else. At day 30, 16 days after the course, vaginal odor had dropped from 48 of the 52 women (92.3%) to 1 (1.9%); the Nugent score, a lab measure of BV bacteria, fell from 7.8 to 3.1, with 88.5% of women in the normal range; and itching fell from 73.1% to 9.6%, vaginal pain from 84.6% to 5.8% and pain during sex from 80.8% to 11.5%. Dryness didn't change significantly and mild side effects affected 7.8%, in a single group of women who completed the course, with no comparison group.23 In the Detroit clinic's earlier, unpublished experience, boric acid alone eased odor but didn't control BV, which is why that regimen pairs it with an antibiotic.22

Researchers are also refining the remedy. In a randomized trial of 106 women at two U.S. sexual health clinics (53 with BV, 36 with a yeast infection and 17 with both), an investigational boric acid product with EDTA added, used for 7 nights as an insert or a gel, cleared BV in 59% (insert) and 50% (gel) and yeast infections in 92% and 81% at 9 to 12 days. The researchers who judged the results didn't know which form each woman used, and there was no placebo group. Burning was the most common side effect, at 9.6%, and no woman developed a new yeast infection.19

How were boric acid suppositories used in the studies?

The CDC regimen and the early trials used gelatin capsules, and gelatin can come from pork, so if you use capsules, choose a bovine, fish or plant-based shell.

Get a diagnosis first

Yeast and BV can feel alike, but they leave different clues: BV tends to bring a thin, clear, white or gray discharge with a fishy odor and a vaginal pH above 4.5, while yeast tends to bring itching and a thick, white discharge without odor, with a normal pH.30 BV is often silent, too: in a U.S. national survey of women aged 14 to 49, 29.2% had BV, and only 15.7% of them reported symptoms.33

The CDC's guidelines diagnose BV from those signs plus a microscope check of the vaginal fluid, or from a lab test.8 For a yeast infection that keeps coming back, they call for a vaginal culture or PCR test to confirm it and identify non-albicans species, so ask your doctor for one.4 It matters because a positive culture doesn't always explain the symptoms: at a Philadelphia vaginitis center, a non-albicans yeast on culture caused the symptoms in only about half of the women who had one.16

The course matters as well. In a survey of 206 new patients at a vulvovaginal health center, half had used boric acid, and only 2.9% had used it for more than 21 days; the CDC's courses run 21 days.3448 The 600 mg amount used in the studies hasn't been tested against other amounts, so the studied courses are the ones to know.2

Maintenance for infections that keep coming back

For yeast infections or BV that keep returning, some practitioners keep boric acid going after the first course. In a chart review of 78 women at Johns Hopkins clinics, prescribers used a 7- to 14-day course, then 300 or 600 mg two to three times a week; women stayed on it for an average of 13.3 months, 76.9% were satisfied, and side effects were uncommon.26 A panel of five vulvovaginal experts lists boric acid among the topical options for maintenance, most often twice a week.32 The effect lasts about as long as the routine: in the nonrandomized comparison of 22 women in the table above, 54.5% relapsed within 6 months of stopping, whether they'd used boric acid or oral itraconazole.25 That's where the root causes come in.

Why do yeast infections keep coming back?

Keeping an infection from returning means changing the conditions that let it take hold. Yeast overgrowth almost never has one cause. In my Candida Cleanse Protocol, antibiotics are the number one cause by a wide margin, followed by sugar, refined flour and alcohol; the hormonal and chemical shifts from birth control, steroids and acid blockers; and chronic stress, and usually two or three of them are stacked on top of each other.9

Blood sugar is one of those drivers. Sugar is the fuel yeast ferments, and in the trial of 111 women with diabetes described above, C. glabrata, a species that often resists azole drugs, caused 61.3% of the yeast infections.93 The candida diet cuts the sugar, refined flour and alcohol that feed yeast, and if you have diabetes, keeping your blood sugar steady is part of the same work.

Rebuild with probiotics

After the causes, my protocol rebuilds. It pairs S. boulardii, a beneficial yeast that crowds out Candida, with a multi-strain probiotic that includes L. rhamnosus, L. reuteri and L. acidophilus, and it keeps both going for 60 to 90 days after the cleanse, because that's what keeps yeast from coming back.9

The research supports probiotics as an add-on. In a Cochrane review of 10 randomized trials with 1,656 nonpregnant women treated for a yeast infection (trials in recurrent infections or diabetes weren't included), probiotics added to antifungal treatment meant about 14% more women had their symptoms clear in the short term and cut relapse at one month by about two-thirds, with low- to very-low-quality evidence and no clear difference by 3 months.35 For BV, in a placebo-controlled trial of 228 women in which neither the women nor the researchers knew who got what, a vaginal Lactobacillus crispatus product used after an antibiotic gel cut recurrence by week 12 to 30%, against 45% on placebo.31 Across 8 trials of 562 women, Lactobacillus vaginal tablets in general didn't significantly lower BV recurrence, and researchers are still working out which strains help most.36 Probiotics for vaginal health covers the strains and the probiotic foods that support them.

Does boric acid kill roaches?

Yes, slowly and for a long time. Boric acid acts on insects as a stomach poison, and borate salts also wear at their outer shells.1 German cockroaches die from walking through the dust as well as from eating it, while bed bugs survived contact with boric acid dust in a lab study and died only when it was in their blood meal.13

According to the University of California's pest management program, boric acid powder may take 7 days or more to make a dent in a cockroach population. It doesn't repel them, and as long as it stays dry and undisturbed, it keeps working for a very long time, but a deposit that gets wet and then cakes loses its electrostatic charge and roaches stop picking it up. Apply it only in enclosed, out-of-the-way spots, and keep it indoors, since it's toxic to plants.12 The safety section covers storing it around children and pets.

Boric acid side effects and safety

In vaginal use, the side effects stay local. Across 14 studies, burning affected fewer than 10% of women, along with a watery discharge during treatment and redness, and a 2024 review put side effects at 7.3%, mild and temporary.2021 A 2021 safety review counted more than 1,100 published patient uses, mostly 600 mg once or twice a day for 7 to 14 days. The only serious harm it found came in an 1888 report of women treated with packs of 25 to 100 times today's amount; since then, the documented problems have been sporadic and mild, mainly local irritation or watery discharge.2 Its authors judged it likely safe at the usual doses, and little reaches the bloodstream through healthy tissue, as the measurements in the diagram above show.2

The danger comes from swallowing it. Between 81% and 95% of a swallowed dose is absorbed, and estimates from accidental poisonings put the smallest deadly amount at 5 to 20 grams for adults, 3 to 6 grams for children and under 5 grams for infants.1 Most accidental swallows are mild: in 784 cases at two poison centers, 88.3% caused no symptoms and none caused severe toxicity, with vomiting, stomach pain and diarrhea the most common complaints.37 Deaths have come from large amounts swallowed and, historically, from boric acid ointments used for diaper rash on infants' skin in the late 1800s.2 As of 1992, the only adult death reported from swallowing boric acid in recent years followed about two cups of crystals swallowed on purpose and left untreated for 3 days.38

Because a vaginal capsule looks like a pill, mix-ups happen: after a woman swallowed one by mistake, medication-safety experts asked makers for suppository shapes, blister packs and "for vaginal insertion only" labels, and Poison Control says the amount in a suppository is unlikely to cause significant toxicity if swallowed.3940

Pregnancy is the other firm line. High doses of boric acid by mouth caused skeletal birth defects in pregnant rats, and in a Hungarian case-control study comparing 22,843 babies with birth defects with 38,151 without, women who used vaginal boric acid in months 2 and 3 of pregnancy had 2.8 times the odds of a baby with a birth defect, a signal limited by small numbers and by mothers' recall.241 Canadian and British guidelines advise against it in pregnancy, and a panel of U.S. experts lists it among the treatments to avoid in pregnancy.232 If you're pregnant and have a yeast infection, your OB may prescribe a 7-day topical azole, the only treatment the CDC recommends in pregnancy.4

The bottom line

Boric acid: frequently asked questions

References

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2. Mittelstaedt R, Kretz A, Levine M, et al. Data on safety of intravaginal boric acid use in pregnant and nonpregnant women: a narrative review. Sex Transm Dis. 2021;48(12):e241-e247. doi:10.1097/OLQ.0000000000001562 · PMID:34561373
3. Ray D, Goswami R, Banerjee U, et al. Prevalence of Candida glabrata and its response to boric acid vaginal suppositories in comparison with oral fluconazole in patients with diabetes and vulvovaginal candidiasis. Diabetes Care. 2007;30(2):312-317. doi:10.2337/dc06-1469 · PMID:17259500
4. Centers for Disease Control and Prevention. Vulvovaginal Candidiasis. Sexually Transmitted Infections Treatment Guidelines, 2021 (published July 22, 2021).
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22. Surapaneni S, Akins R, Sobel JD. Recurrent bacterial vaginosis: an unmet therapeutic challenge. Experience with a combination pharmacotherapy long-term suppressive regimen. Sex Transm Dis. 2021;48(10):761-765. doi:10.1097/OLQ.0000000000001420 · PMID:34110746
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Dr. Josh Axe, DC, DNM, CNS

Doctor of Natural Medicine · Founder, DrAxe.com

Dr. Axe is a certified doctor of natural medicine, clinical nutritionist, and multiple New York Times bestselling author. He has spent 20+ years in clinical practice helping people heal at the root cause and founded one of the most-visited natural-health platforms in the world.

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