How is Bacterial Vaginosis (BV) tested in males?

Bacterial Vaginosis (BV) Testing in Males

Bacterial vaginosis (BV) is not routinely tested for in males as there is no standardized diagnostic approach for BV in men, and male partner treatment has only recently been shown to be beneficial in preventing BV recurrence in women.

Diagnostic Challenges for BV in Males

• BV is primarily diagnosed and defined as a condition affecting the vaginal microbiome, characterized by replacement of normal H₂O₂-producing Lactobacillus species with anaerobic bacteria, Gardnerella vaginalis, and Mycoplasma hominis 1
• There are no established clinical criteria for diagnosing BV in males similar to the Amsel criteria used for women (which include vaginal discharge characteristics, clue cells, pH >4.5, and positive whiff test) 2
• Historically, the CDC has not recommended routine testing or treatment of male partners for BV as it was not considered to improve clinical outcomes in women 2, 1

Recent Evidence on Male Partner Testing and Treatment

• The most recent high-quality evidence (2025) from a randomized controlled trial shows that treating male partners can significantly reduce BV recurrence rates in women, challenging previous recommendations 3
• This trial was stopped early because treating both the woman and her male partner was superior to treating only the woman, with recurrence rates of 35% vs 63% respectively 3
• Despite this evidence for treatment, there remains no standardized diagnostic approach for detecting BV organisms in males 3

Current Approaches to Detecting BV-Associated Organisms in Males

• When testing has been performed in research settings, methods have included:
  • Penile skin swabs for molecular detection of BV-associated organisms 4, 3
  • Culture techniques for detecting Gardnerella vaginalis, though these have poor specificity (positive predictive value less than 50%) 5
• Unlike in women, there is no equivalent to the vaginal Gram stain scoring system (Nugent score) for males 2, 5

Clinical Implications

• Testing for BV in males is primarily relevant in the context of recurrent BV in female partners 4, 3
• The recent evidence suggests that empiric treatment of male partners without specific testing may be beneficial in preventing BV recurrence in women 3
• Male partner treatment in the successful trial consisted of oral metronidazole 400 mg twice daily plus 2% clindamycin cream applied to the glans penis and upper shaft twice daily for 7 days 3

Cautions and Considerations

• Routine screening of asymptomatic men for BV-associated organisms is not recommended 6
• Testing for other urogenital mycoplasmas (M. hominis, U. parvum, U. urealyticum) in asymptomatic men can lead to unnecessary treatment and potential antimicrobial resistance 6
• When evaluating males with urethritis symptoms, other traditional STI agents (N. gonorrhoeae, C. trachomatis, M. genitalium, T. vaginalis) should be excluded before considering testing for BV-associated organisms 6

In conclusion, while there is emerging evidence supporting treatment of male partners to prevent BV recurrence in women, there remains no standardized diagnostic approach for BV in males. The focus has shifted toward empiric treatment rather than diagnostic testing in males.