From the Guidelines
Current guidelines do not recommend routine treatment of male sexual partners for women with bacterial vaginosis (BV). While the woman should be treated with either oral metronidazole (500 mg twice daily for 7 days), vaginal metronidazole gel (0.75%, one applicator daily for 5 days), or vaginal clindamycin cream (2%, one applicator at bedtime for 7 days), treating her partner has not been shown to reduce recurrence rates or improve cure rates 1. The reason for this is that BV is not considered a sexually transmitted infection in the traditional sense, but rather a disruption of the normal vaginal microbiome. Although sexual activity can influence BV development, studies have consistently failed to demonstrate benefit from partner treatment.
Key Points to Consider
- BV is a clinical syndrome resulting from replacement of the normal H2O2-producing Lactobacillus sp. in the vagina with high concentrations of anaerobic bacteria, G. vaginalis, and Mycoplasma hominis 1
- Treatment of the male sex partner has not been beneficial in preventing the recurrence of BV 1
- The recommended treatment regimen includes oral or topical metronidazole or clindamycin cream 1
- For women with recurrent BV, strategies like suppressive therapy with metronidazole gel twice weekly for 4-6 months may be more beneficial than partner treatment. If the partner has already been treated with metronidazole and clindamycin, no harm is likely done, but this is not necessary for future episodes.
From the Research
Treatment of Bacterial Vaginosis in Women and Their Partners
- The current recommended treatment for bacterial vaginosis in women includes antimicrobial agents such as metronidazole and clindamycin 2, 3, 4, 5, 6.
- A study published in 2025 found that treating the male partner with oral and topical antimicrobial treatment (metronidazole 400-mg tablets and 2% clindamycin cream applied to penile skin, both twice daily for 7 days) in addition to treating the woman with first-line recommended antimicrobial agents, resulted in a lower rate of recurrence of bacterial vaginosis within 12 weeks compared to standard care 2.
- The treatment of bacterial vaginosis in women typically involves oral metronidazole, intravaginal metronidazole, or intravaginal clindamycin 3, 4, 5, 6.
- Alternative strategies for treating bacterial vaginosis are being explored, including probiotics, vaginal microbiome transplantation, pH modulation, and biofilm disruption 3, 5.
Treatment of Male Partners
- The study published in 2025 found that treating the male partner with metronidazole and clindamycin reduced the recurrence rate of bacterial vaginosis in their female partner 2.
- Adverse events reported in treated men included nausea, headache, and metallic taste 2.
- Previous studies did not support the practice of routine treatment of male sex partners of infected females 4.
Recurrence of Bacterial Vaginosis
- Bacterial vaginosis has a high recurrence rate, with 50-80% of women experiencing a recurrence within a year of completing antibiotic treatment 3.
- The recurrence rate may be due to the inability of antibiotics to eradicate polymicrobial biofilms and failure to reestablish acidic pH and the lactobacillus-dominated commensal flora 3, 5.