Does a male partner need to be treated when a female has bacterial vaginosis?

Treatment of Male Partners in Bacterial Vaginosis

Routine treatment of male sex partners is not recommended for women with bacterial vaginosis (BV) as it has not been shown to influence a woman's response to therapy or reduce recurrence rates.

Evidence-Based Recommendation

• According to the Centers for Disease Control and Prevention (CDC) guidelines, treatment of sex partners has not been shown to influence the woman's response to therapy or affect relapse/recurrence rates 1
• The principal goal of therapy for BV is to relieve vaginal symptoms and signs of infection in the affected woman, not to prevent transmission 1
• Because male sex partners of women with BV are typically asymptomatic, treating them has traditionally not been considered necessary 1

Recent Research Developments

• A 2025 randomized controlled trial (StepUp trial) challenges the traditional recommendation, finding that combined oral and topical antimicrobial therapy for male partners resulted in a lower rate of BV recurrence within 12 weeks compared to standard care 2
• In this study, women whose male partners received treatment (oral metronidazole 400 mg tablets and 2% clindamycin cream applied to penile skin, both twice daily for 7 days) had a 35% recurrence rate compared to 63% in the control group 2
• The trial was stopped early because treatment of the woman only was found to be inferior to treatment of both partners 2

Clinical Implications

• Despite this new evidence, current CDC guidelines still do not recommend routine treatment of male partners 3
• BV recurrence is common, with 50-80% of women experiencing recurrence within a year of completing antibiotic treatment 4
• Potential mechanisms for recurrence include:
  • Persistence of residual infection
  • Formation of bacterial biofilms that protect BV-causing bacteria
  • Reinfection from sexual partners 5

Treatment Considerations for Women with BV

• First-line treatment options for women with BV include:
  • Oral metronidazole 500 mg twice daily for 7 days (95% cure rate) 3
  • Metronidazole gel 0.75%, one full applicator intravaginally daily for 5 days 3
  • Clindamycin cream 2%, one full applicator intravaginally at bedtime for 7 days 3
• Alternative options include:
  • Oral metronidazole 2g as a single dose (84% cure rate) 3
  • Oral clindamycin 300 mg twice daily for 7 days 3

Special Considerations

• For recurrent BV, extended treatment courses may be considered:
  • Metronidazole 500 mg twice daily for 10-14 days 5
  • Metronidazole vaginal gel 0.75% for 10 days, followed by twice weekly for 3-6 months 5
• Patients using metronidazole should avoid alcohol during treatment and for 24 hours afterward due to potential disulfiram-like reaction 1, 3
• Clindamycin cream is oil-based and may weaken latex condoms and diaphragms 1, 3

Conclusion

While traditional guidelines do not recommend treating male partners of women with BV, emerging research suggests potential benefits in reducing recurrence rates. However, until this evidence is incorporated into official guidelines, the standard recommendation remains that routine treatment of male sex partners is not necessary.