Can males develop bacterial vaginosis (BV)?

Males Cannot Have Bacterial Vaginosis

Males cannot develop bacterial vaginosis (BV) as it is a condition specifically affecting the vaginal microbiome. BV is characterized by an alteration in vaginal ecology where Lactobacillus species are replaced by anaerobic bacteria 1.

Understanding Bacterial Vaginosis

Bacterial vaginosis is defined by specific clinical and microbiological features that are unique to the vaginal environment:

• It involves disruption of normal vaginal flora (predominantly Lactobacillus species)
• It presents with characteristic vaginal discharge and elevated vaginal pH (>4.5)
• Diagnosis requires specific findings including clue cells and positive "whiff test" 1

The diagnostic criteria for BV according to CDC guidelines include:

• Homogeneous, white, thin vaginal discharge
• Fishy or musty odor
• Vaginal pH >4.5
• Presence of clue cells on microscopy 1

Why Males Cannot Have BV

Males cannot have bacterial vaginosis for several anatomical and physiological reasons:

1. Anatomical differences: Males lack a vagina, which is the specific environment where BV occurs
2. Microbiome differences: The normal vaginal flora dominated by Lactobacillus species is not present in male genitourinary anatomy
3. Diagnostic criteria: The clinical criteria used to diagnose BV (Amsel criteria, Nugent scoring) are specifically designed for vaginal specimens 2

Male Partners and BV

While males cannot develop BV themselves, they can play a role in BV transmission and recurrence:

• Recent evidence suggests sexual exchange of BV-associated organisms between partners 3
• Male partners may serve as reservoirs for BV-associated bacteria
• Treatment of male partners may reduce BV recurrence in female partners

A recent high-quality study published in the New England Journal of Medicine (2025) demonstrated that treating male partners of women with BV significantly reduced recurrence rates. In this study, when both the woman and her male partner received treatment, the recurrence rate was 35% compared to 63% when only the woman was treated 3.

Clinical Implications

Although males cannot have BV, clinicians should be aware that:

• Male partners may harbor BV-associated organisms on penile skin
• Treatment of male partners with oral metronidazole and topical clindamycin may be beneficial in preventing recurrence in female partners 3
• The rectum may serve as a reservoir for some BV-associated flora in both sexes 4

Common Misconceptions

A common misconception is that males can have "BV-like" conditions. However:

• While males can harbor some of the same bacteria associated with BV, this colonization does not constitute BV
• Male urethritis or balanitis caused by similar organisms is a distinct clinical entity and not BV
• The term "bacterial vaginosis" specifically refers to the vaginal condition with its characteristic diagnostic criteria 1, 2

In conclusion, bacterial vaginosis is a condition specific to the vaginal environment and cannot occur in males due to fundamental anatomical and microbiological differences.