Is the male partner treated for bacterial vaginosis (BV)?

Treatment of Male Partners for Bacterial Vaginosis

Based on the most recent high-quality evidence, treating male partners of women with bacterial vaginosis significantly reduces BV recurrence rates and should be considered as part of the treatment approach. 1

Current Evidence on Male Partner Treatment

The traditional approach to bacterial vaginosis (BV) has not included male partner treatment. However, recent evidence challenges this practice:

• The 2025 New England Journal of Medicine study demonstrated that treating male partners with combined oral metronidazole and topical clindamycin significantly reduced BV recurrence rates in women (35% vs 63% in the control group) 1
• This landmark study was stopped early by the data safety monitoring board because treating only the woman was found to be inferior to treating both partners 1
• The absolute risk difference was -2.6 recurrences per person-year (95% CI, -4.0 to -1.2; P<0.001) 1

Treatment Recommendations

For Women with BV:

• First-line treatment remains:
  • Metronidazole 500 mg orally twice daily for 7 days (95% cure rate) 2
  • Alternative options: metronidazole gel 0.75% intravaginally once daily for 5 days or clindamycin cream 2% intravaginally at bedtime for 7 days 2

For Male Partners:

• Based on the most recent evidence, consider:
  • Oral metronidazole 400 mg twice daily for 7 days AND
  • 2% clindamycin cream applied topically to the glans penis and upper shaft (under foreskin if uncircumcised) twice daily for 7 days 1

Important Clinical Considerations

• Adherence matters: Studies show that male partner adherence to treatment regimens significantly impacts treatment success 3
• Common side effects in treated men include nausea, headache, and metallic taste 1
• Alcohol avoidance: Both partners should avoid alcohol during metronidazole treatment and for 24 hours afterward 2
• Sexual abstinence: Couples should refrain from unprotected sex for 14 days during treatment 3

Recurrent BV Management

For women with recurrent BV (which affects up to 50% of women within 1 year of treatment):

• Extended course of metronidazole (500 mg twice daily for 10-14 days) 4
• If ineffective, consider metronidazole vaginal gel 0.75% for 10 days, followed by twice weekly application for 3-6 months 4
• Consider male partner treatment as described above, especially given the new evidence 1

Rationale for Partner Treatment

The high recurrence rates of BV (up to 50% within one year) may be explained by:

• Persistence of biofilms that protect BV-causing bacteria 4
• Potential reinfection from male partners carrying BV-associated organisms 5, 1
• The sexual transmissibility component of BV suggested by epidemiologic and microbiologic data 5

Caution and Limitations

• Prior to the 2025 NEJM study, evidence for male partner treatment was inconclusive, with previous trials having significant methodological flaws 5
• The CDC guidelines have not yet been updated to reflect this new evidence 2
• Treatment decisions should consider the strength of this new evidence against historical recommendations

The paradigm for BV management appears to be shifting based on this compelling new evidence, suggesting that treating male partners may significantly improve outcomes for women with BV.