From the Guidelines
Partner treatment for bacterial vaginosis (BV) is not routinely recommended. Current evidence does not support treating male or female partners of women with BV as this practice has not been shown to reduce recurrence rates or improve outcomes 1. BV is characterized by an imbalance in the vaginal microbiome rather than a traditional sexually transmitted infection, although sexual activity can be associated with its development. For the woman diagnosed with BV, treatment typically involves metronidazole (500 mg orally twice daily for 7 days, or 0.75% gel intravaginally once daily for 5 days) or clindamycin (300 mg orally twice daily for 7 days, or 2% cream intravaginally at bedtime for 7 days) 1.
Key Points to Consider
- The cause of the microbial alteration in BV is not fully understood, but it is associated with having multiple sex partners, douching, and lack of vaginal lactobacilli 1.
- Women who have never been sexually active are rarely affected by BV 1.
- Treatment of the male sex partner has not been beneficial in preventing the recurrence of BV 1.
- While BV can recur in up to 50% of women within 12 months of treatment, partner treatment has not been demonstrated to prevent these recurrences 1.
- Instead, women with recurrent BV may benefit from extended or suppressive therapy regimens.
Treatment Focus
The focus should remain on treating the affected woman rather than her partners, as the underlying mechanism involves restoration of the normal vaginal flora rather than elimination of a transmitted pathogen.
Additional Considerations
- Patients should be advised to avoid consuming alcohol during treatment with metronidazole and for 24 hours thereafter 1.
- Clindamycin cream and ovules are oil-based and might weaken latex condoms and diaphragms 1.
From the Research
Partner Treatment of Bacterial Vaginosis
- The treatment of bacterial vaginosis typically focuses on the female patient, with recommended treatments including metronidazole, clindamycin, or tinidazole orally or intravaginally 2, 3, 4.
- Historically, data did not support routine treatment of male sex partners 2.
- However, a recent study suggests that treating the male partner with oral and topical antimicrobial treatment (metronidazole and 2% clindamycin cream) in addition to treating the female partner can reduce the recurrence of bacterial vaginosis within 12 weeks 5.
- This study found that the recurrence rate of bacterial vaginosis was significantly lower in the partner-treatment group compared to the control group, with an absolute risk difference of -2.6 recurrences per person-year 5.
- Other studies have explored alternative strategies for treating bacterial vaginosis, including the use of probiotics and antimicrobial substances, but the effectiveness of these approaches is still being researched 3, 6.
- The use of oral metronidazole with vaginal clindamycin or vaginal probiotic has been studied, but one trial found no difference in bacterial vaginosis recurrence rates between these groups and a placebo group 6.