What is the management approach for a 15-year-old male diagnosed with bacterial vaginosis (BV)?

Management of Bacterial Vaginosis in a 15-Year-Old Male

Bacterial vaginosis (BV) is a condition that affects the vagina and does not occur in males, as males do not have vaginal anatomy. 1, 2

Understanding the Diagnostic Error

• BV is a clinical syndrome resulting from replacement of normal H₂O₂-producing Lactobacillus species in the vagina with high concentrations of anaerobic bacteria, Gardnerella vaginalis, and Mycoplasma hominis 1, 2
• BV is diagnosed using specific criteria (Amsel criteria) that require three of the following:
  • Homogeneous, white, non-inflammatory discharge that adheres to vaginal walls
  • Presence of clue cells on microscopic examination
  • pH of vaginal fluid greater than 4.5
  • Fishy odor of vaginal discharge before or after addition of 10% KOH (whiff test) 1, 3
• These diagnostic criteria are specific to female anatomy and cannot be applied to males 1

Appropriate Next Steps

• Reevaluate the diagnosis, as BV cannot occur in males 1, 2
• Consider alternative diagnoses that might present with similar symptoms in males:
  • Urethritis (gonococcal or non-gonococcal)
  • Balanitis
  • Sexually transmitted infections 1
• Obtain a detailed sexual history to guide appropriate testing 1
• Perform appropriate diagnostic testing based on symptoms:
  • Urethral swabs for gonorrhea and chlamydia
  • Urine testing for urinary tract infection
  • Physical examination for other genital conditions 1

Important Clinical Considerations

• If the patient is a sexual partner of a female with BV, treatment of male partners has not been shown to alter the clinical course of BV in women or prevent recurrence 1, 3
• The CDC explicitly states that "treatment of male sex partners has not been found beneficial in preventing the recurrence of BV" 1
• BV is associated with sexual activity in women but is not considered exclusively a sexually transmitted disease 1
• If the patient has symptoms suggestive of a different condition, appropriate testing and treatment should be pursued based on those findings 1

Common Pitfalls to Avoid

• Misdiagnosing conditions in males that are specific to female anatomy 1, 2
• Treating male partners of women with BV unnecessarily, as this practice is not supported by evidence 1, 3
• Failing to consider alternative diagnoses that might better explain the patient's symptoms 1
• Not obtaining appropriate diagnostic tests for conditions that can affect male genitourinary anatomy 1