Do males require treatment for bacterial vaginosis (BV) if their female partner is diagnosed with BV?

Treatment of Male Partners for Bacterial Vaginosis

Male partners of women with bacterial vaginosis (BV) do not require treatment according to established guidelines, as treatment of male partners has not been shown to consistently prevent BV recurrence in women. 1

Understanding Bacterial Vaginosis and Male Partners

Bacterial vaginosis is a clinical syndrome resulting from the replacement of normal H₂O₂-producing Lactobacillus species in the vagina with high concentrations of anaerobic bacteria. While BV is associated with sexual activity and having multiple sex partners, it is not classified as a conventional sexually transmitted disease 2, 1.

Key points regarding male partners and BV:

• The bacteria associated with BV may be part of the normal male genital flora 1
• Male partners of women with BV do not develop a "male version" of bacterial vaginosis 1
• Male partners are typically asymptomatic 1

Evidence on Male Partner Treatment

Traditional guidelines from the Centers for Disease Control and Prevention (CDC) have consistently stated that "treatment of male sex partner has not been beneficial in preventing the recurrence of BV" 2. This recommendation has been based on several randomized controlled trials that did not find a uniformly beneficial effect of male partner treatment.

However, it's important to note that recent research has shown conflicting results:

• A 2025 open-label randomized controlled trial published in The New England Journal of Medicine found that treatment of both the woman and her male partner resulted in a lower rate of BV recurrence within 12 weeks compared to treating only the woman 3. The trial was stopped early because treatment of the woman only was found to be inferior to treating both partners.

• In contrast, a 2021 double-blind, placebo-controlled trial found no significant difference in BV recurrence rates between women whose male partners received metronidazole versus placebo 4. However, a subgroup analysis showed that women whose male partners adhered to metronidazole treatment were less likely to fail treatment.

Clinical Approach Based on Current Guidelines

Despite these recent findings, current established guidelines still do not recommend routine treatment of male partners of women with BV:

1. Focus treatment on the female patient with confirmed BV using recommended regimens:

   • Metronidazole 500 mg orally twice daily for 7 days, OR
   • Clindamycin cream 2%, one full applicator intravaginally at bedtime for 7 days, OR
   • Metronidazole gel 0.75%, one full applicator intravaginally twice daily for 5 days 2

2. For recurrent BV, extended treatment courses may be considered:

   • Extended course of metronidazole (500 mg twice daily for 10-14 days) 5
   • If ineffective, metronidazole vaginal gel 0.75% for 10 days, followed by twice weekly for 3-6 months 5

Important Considerations and Caveats

• While current guidelines do not recommend male partner treatment, the emerging research suggests this may be reconsidered in future guideline updates, particularly for cases of recurrent BV.

• The systematic review by Mehta (2012) noted that previous trials examining male partner treatment had significant methodological flaws, including suboptimal treatment regimens and limited statistical power 6.

• If considering treatment of male partners in cases of persistent or recurrent BV (outside of current guidelines), be aware that potential side effects in men include nausea, headache, and metallic taste 3.

• Patients using metronidazole should be advised to avoid alcohol during treatment and for 24 hours afterward 2.

• Clindamycin cream is oil-based and might weaken latex condoms and diaphragms 2.