Should the partner of a pregnant patient with recurrent bacterial vaginosis (BV) be treated?

Treatment of Partners in Recurrent Bacterial Vaginosis During Pregnancy

Routine treatment of the male partner of a pregnant patient with recurrent bacterial vaginosis (BV) is not recommended based on established guidelines.

Evidence-Based Rationale

The CDC guidelines clearly state that a woman's response to therapy and the likelihood of relapse or recurrence of BV are not affected by treatment of her sex partner(s) 1. Multiple clinical trials have demonstrated that partner treatment does not improve outcomes for women with BV 1.

Why Partner Treatment Is Not Recommended:

• Clinical trials consistently show that treating male partners does not:
  • Reduce recurrence rates in women
  • Improve clinical response to treatment
  • Affect the likelihood of relapse

Management of Recurrent BV in Pregnancy

For the pregnant patient with recurrent BV, the focus should be on:

1. Proper treatment of the pregnant woman:

   • All symptomatic pregnant women should be tested and treated for BV 1
   • Recommended regimens for pregnant women:
     • Metronidazole 250 mg orally three times a day for 7 days
     • Clindamycin 300 mg orally twice a day for 7 days 1

2. Follow-up evaluation:

   • A follow-up evaluation 1 month after treatment completion is recommended for pregnant women to verify treatment effectiveness 1
   • This is particularly important due to the association between BV and adverse pregnancy outcomes

3. Treatment of recurrences:

   • For recurrent BV, an extended course of metronidazole (500 mg twice daily for 10-14 days) is recommended 2
   • Alternative regimen: metronidazole vaginal gel 0.75% for 10 days, followed by twice weekly for 3-6 months 2

Importance in Pregnancy

BV during pregnancy is associated with serious complications including:

• Premature rupture of membranes
• Preterm labor
• Preterm birth
• Postpartum endometritis 1

Therefore, proper treatment of the pregnant woman is essential, but this does not extend to treating her partner.

Recent Research Developments

It's worth noting that a recent 2025 study has challenged the established guidelines by showing that male-partner treatment (with oral metronidazole and topical clindamycin) reduced BV recurrence rates within 12 weeks compared to standard care 3. However, this single study has not yet been incorporated into clinical guidelines, and the established CDC guidelines still represent the standard of care, especially for pregnant patients where medication safety is paramount.

Key Takeaway

Despite the high recurrence rates of BV (50-80% within a year after treatment) 4, current evidence-based guidelines do not support treating the partners of pregnant women with recurrent BV. The focus should remain on appropriate treatment of the pregnant woman and close follow-up to monitor for recurrence and prevent pregnancy complications.