Does a male partner need to receive treatment if his female partner is diagnosed with bacterial vaginosis (BV)?

Treatment of Male Partners for Women with Bacterial Vaginosis

Male partners of women diagnosed with bacterial vaginosis do not need to receive treatment according to current guidelines, as treatment of male partners has not been shown to alter the clinical course of BV in women during treatment or reduce the relapse/reinfection rate. 1

Evidence Against Routine Male Partner Treatment

• BV is not considered exclusively a sexually transmitted disease, although it is associated with sexual activity and having multiple sex partners 1
• The Centers for Disease Control and Prevention (CDC) guidelines explicitly state that preventing transmission to men is not a goal of BV therapy 1
• Treatment of male sex partners has not been found beneficial in preventing the recurrence of BV according to established guidelines 1, 2

Understanding Bacterial Vaginosis

• BV results from replacement of normal H₂O₂-producing Lactobacillus species with high concentrations of anaerobic bacteria, Gardnerella vaginalis, and Mycoplasma hominis 3
• Diagnosis requires meeting at least 3 of 4 Amsel criteria: homogeneous white discharge, clue cells on microscopy, vaginal pH >4.5, and positive whiff test 2
• BV is the most prevalent cause of vaginal discharge and malodor, with up to 50% of women with BV being asymptomatic 3

Current Treatment Recommendations

• The principal goal of therapy is to relieve vaginal symptoms and signs in the female partner 1
• First-line treatment for women with symptomatic BV is metronidazole 500 mg orally twice daily for 7 days (95% cure rate) 2
• Alternative regimens include metronidazole gel 0.75% intravaginally once daily for 5 days or clindamycin cream 2% intravaginally at bedtime for 7 days 2

Emerging Research on Male Partner Treatment

• Despite longstanding guidelines against male partner treatment, recent research has begun to challenge this approach:
• A 2025 study published in the New England Journal of Medicine found that treating both the woman and her male partner resulted in a lower rate of BV recurrence (35%) compared to standard care (63%) within 12 weeks 4
• This study used a combination of oral metronidazole 400 mg tablets and 2% clindamycin cream applied to penile skin, both twice daily for 7 days for male partners 4
• However, this single study has not yet been incorporated into clinical guidelines and represents a departure from decades of established practice 1, 2

Clinical Considerations

• BV has a high recurrence rate, with up to 50% of women experiencing recurrence within 1 year of treatment 5
• Special consideration should be given to treating BV (symptomatic or asymptomatic) before performing surgical abortion procedures or other invasive gynecological procedures 1, 6
• Patients using metronidazole should avoid alcohol during treatment and for 24 hours afterward due to potential disulfiram-like reaction 1, 2

Conclusion

Based on current guidelines, male partners of women with bacterial vaginosis do not require treatment, as it has not been shown to alter the clinical course of BV or prevent recurrence 1, 2. While emerging research suggests potential benefits of male partner treatment 4, this approach has not yet been incorporated into clinical practice guidelines.