What is the treatment for bacterial vaginosis (BV) in men?

Treatment for Bacterial Vaginosis in Men

Male partners of women with bacterial vaginosis should be treated with a combination of oral metronidazole 400 mg twice daily and 2% clindamycin cream applied topically to the glans penis and upper shaft (under the foreskin if uncircumcised) twice daily for 7 days to prevent recurrence of BV in female partners. 1

Evidence for Male Partner Treatment

The treatment of bacterial vaginosis (BV) has traditionally focused solely on treating women, with no specific recommendations for treating male partners. However, recent high-quality evidence has changed this approach:

• A 2025 randomized controlled trial published in the New England Journal of Medicine demonstrated that treating male partners significantly reduced BV recurrence rates in women 1
• The trial was stopped early because treating only the woman was found to be inferior to treating both partners
• BV recurrence occurred in only 35% of women whose partners received treatment compared to 63% in the standard care group (absolute risk difference of -2.6 recurrences per person-year) 1

Treatment Regimen for Men

Based on the most recent evidence, the recommended treatment for male partners includes:

• Oral metronidazole 400 mg twice daily for 7 days AND
• 2% clindamycin cream applied topically to the glans penis and upper shaft (under the foreskin if uncircumcised) twice daily for 7 days 1

Rationale for Male Partner Treatment

The rationale for treating male partners stems from evidence suggesting sexual transmission of BV-associated organisms:

• Male partners may harbor BV-associated bacteria and reinfect female partners 2
• Traditional approaches treating only women result in high recurrence rates (up to 50% within 1 year) 3
• The formation of biofilms may protect BV-causing bacteria from antimicrobial therapy, contributing to persistence 3

Important Considerations and Potential Side Effects

When prescribing treatment for male partners, be aware of:

1. Potential side effects in men:

   • Nausea
   • Headache
   • Metallic taste 1

2. Contraindications:

   • Advise against alcohol consumption during metronidazole treatment and for 24 hours afterward due to disulfiram-like reactions 4

3. Condom use:

   • Clindamycin cream is oil-based and may weaken latex condoms 4
   • Recommend abstinence or non-latex barriers during treatment

Caution Regarding Alternative Approaches

It's important to note that not all topical applications are beneficial:

• A 2011 study found that topical application of 62% ethyl alcohol in emollient gel to the penis actually increased BV persistence or early recurrence in female partners 5
• This highlights the importance of using evidence-based treatments rather than alternative approaches

Follow-up Recommendations

After treatment:

• Partners should complete the full 7-day course of treatment
• Couples should be advised to return for follow-up if the woman's symptoms persist or recur
• Consider extended treatment courses for women with recurrent BV (metronidazole 500 mg twice daily for 10-14 days) 3

The evidence clearly supports treating male partners of women with BV using a combination of oral and topical antimicrobials to reduce recurrence rates and improve outcomes for women with this common condition.