Does a male partner require metronidazole (antibiotic) treatment if his female partner has bacterial vaginosis (BV)?

Male Partner Treatment for Bacterial Vaginosis

Male partners of women with bacterial vaginosis do not require metronidazole treatment as it has not been shown to affect the clinical course of BV in women or prevent recurrence according to established guidelines. 1, 2

Understanding Bacterial Vaginosis and Partner Treatment

Bacterial vaginosis (BV) is characterized by an alteration of the normal vaginal flora, where hydrogen peroxide-producing lactobacilli are replaced by high concentrations of anaerobic bacteria. While BV is associated with sexual activity and multiple partners, it is not classified as a conventional sexually transmitted disease 2.

Evidence Against Male Partner Treatment:

• The CDC guidelines clearly state that male sex partners of women with BV do not require treatment 1, 2
• Male partners typically remain asymptomatic 2
• Traditional treatment approaches focus solely on the female patient 1
• Treatment of male partners has not been shown to alter:
  • The clinical course of BV during treatment
  • The relapse or recurrence rate in women 1

Treatment Recommendations for Women:

For women diagnosed with BV, the CDC recommends:

1. Metronidazole 500 mg orally twice daily for 7 days (95% cure rate) 1
2. Alternative options:
   • Metronidazole 2g orally in a single dose (84% cure rate) 1
   • Clindamycin cream 2%, one full applicator intravaginally at bedtime for 7 days 1, 2
   • Metronidazole gel 0.75%, one full applicator intravaginally twice daily for 5 days 1, 2

Important Clinical Considerations

Recurrence of BV:

BV commonly recurs even with appropriate treatment of the female patient. The recurrence rate can be as high as 70% in long-term follow-up 3. This high recurrence rate exists regardless of whether male partners are treated.

Emerging Research:

While established guidelines do not recommend male partner treatment, a recent 2025 study suggests that combined oral and topical antimicrobial therapy for male partners may lower the rate of BV recurrence within 12 weeks 4. However, this single study has not yet been incorporated into clinical guidelines and contradicts multiple previous studies and established recommendations.

Practical Advice:

• Focus treatment on the female patient with confirmed BV
• Advise patients using metronidazole to avoid alcohol during treatment and for 24 hours afterward 1
• Note that clindamycin cream is oil-based and might weaken latex condoms and diaphragms 2
• Follow-up visits are not necessary if symptoms resolve 1

Conclusion

Based on current guidelines, treating male partners of women with BV is not recommended as part of standard care. The treatment focus should remain on the female patient with confirmed bacterial vaginosis using established antibiotic regimens.