Testing Male Partners for Bacteria Associated with Bacterial Vaginosis
Currently, routine testing of male partners for bacteria associated with bacterial vaginosis (BV) is not recommended by clinical guidelines, as treatment of male partners has traditionally not been shown to prevent BV recurrence in women. 1, 2, 3
Understanding BV and Male Partner Involvement
- BV is characterized by replacement of normal H₂O₂-producing Lactobacillus species with high concentrations of anaerobic bacteria, Gardnerella vaginalis, and Mycoplasma hominis 1, 2
- BV is associated with having multiple sexual partners, though it's unclear whether BV results from acquisition of a sexually transmitted pathogen 1
- Women who have never been sexually active rarely develop BV, suggesting some sexual component to transmission 1, 3
- Men can carry BV-associated bacteria on the penis without symptoms 3, 4
Traditional Approach to Male Partners
- According to longstanding CDC guidelines, treatment of male sex partners has not been beneficial in preventing the recurrence of BV 1, 3
- Standard diagnostic tests for BV (Amsel criteria or Gram stain) are designed for women and not validated for use in men 1, 5
- There are no FDA-approved or guideline-recommended tests specifically for detecting BV-associated bacteria in men 1, 3
Emerging Evidence on Male Partner Testing and Treatment
- Recent research suggests that the uncircumcised penis can be an important reservoir for BV-associated bacteria 4
- A 2025 randomized controlled trial found that treating both women with BV and their male partners resulted in significantly lower BV recurrence rates compared to treating women alone 6
- This groundbreaking study showed recurrence in only 35% of women whose partners received treatment versus 63% in the standard care group 6
Current Testing Options for Male Partners
- While not routinely recommended, some testing approaches that could potentially be used include:
- Penile swabs for microbiome analysis using 16S rRNA gene-based sequencing (research tool, not clinically available) 4
- Culture for specific BV-associated organisms (limited clinical utility as many organisms are difficult to culture) 1
- DNA probe-based tests that detect G. vaginalis could potentially be adapted for penile samples, though not FDA-approved for this purpose 1
Important Considerations
- Most clinical laboratories do not offer specific testing for BV-associated bacteria in men 1, 3
- If you're experiencing recurrent BV despite appropriate treatment, discussing the new evidence on partner treatment with your healthcare provider may be worthwhile 6
- The treatment used in the recent successful trial included both oral metronidazole (400 mg twice daily) and topical 2% clindamycin cream applied to the penis twice daily for 7 days 6
- Be aware that male partners treated with metronidazole should avoid alcohol during treatment and for 24 hours afterward 3
Bottom Line
While traditional guidelines don't recommend routine testing or treatment of male partners for BV, emerging evidence suggests this approach may need reconsideration, especially for women with recurrent BV. Discuss these newer findings with your healthcare provider to determine the most appropriate approach for your specific situation.