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

Treatment of Bacterial Vaginosis in Men

Treatment of male partners of women with bacterial vaginosis is not routinely recommended as it has not been shown to prevent recurrence of BV in women according to established guidelines. 1

Understanding Bacterial Vaginosis in Men

• Bacterial vaginosis (BV) is not considered a condition that affects men directly, but rather a clinical syndrome in women resulting from replacement of normal vaginal flora with anaerobic bacteria 1
• Men are not typically symptomatic even when carrying BV-associated bacteria 1
• BV is associated with sexual activity, as women who have never been sexually active rarely develop BV 1, 2

Traditional Approach to Male Partners

• According to CDC guidelines, treatment of male sex partners has not been found beneficial in preventing the recurrence of BV in women 1
• The principal goal of BV therapy is to relieve vaginal symptoms and signs in women, not to prevent transmission to men 1
• Historically, preventing transmission to men has not been considered a goal of therapy 1

Recent Research Developments

• A 2025 randomized controlled trial (StepUp) found that combined treatment of both women and their male partners resulted in significantly lower BV recurrence rates compared to treating women alone 3
• In this trial, male partners received oral metronidazole 400 mg twice daily plus 2% clindamycin cream applied topically to the penile skin twice daily for 7 days 3
• The recurrence rate was 35% in the partner-treatment group versus 63% in the control group (standard care) within 12 weeks 3

Treatment Considerations

• If treatment of male partners is considered based on recent evidence:
  • Oral metronidazole 400 mg twice daily for 7 days plus 2% clindamycin cream applied topically to the penile skin (glans and upper shaft, under foreskin if uncircumcised) twice daily for 7 days 4, 5, 3
• Common side effects in men receiving treatment include:
  • Nausea, headache, and metallic taste 3
  • Men should avoid alcohol during treatment with metronidazole and for 24 hours afterward 1

Important Caveats

• It's important to distinguish BV from other conditions like candidiasis, which requires antifungal treatment rather than antibiotics 6, 7
• The traditional standard of care based on older guidelines does not recommend male partner treatment 1
• The decision to treat male partners should be made with awareness that this approach represents a departure from long-standing guidelines but is supported by recent high-quality evidence 3

Follow-Up Considerations

• If treating male partners based on recent evidence, adherence to the full treatment course is important for efficacy 8
• Male partners should be counseled about potential side effects and the importance of completing the full course of treatment 4, 5
• Men should refrain from unprotected sex during the treatment period (typically 7-14 days) 9, 8