Should the male sex partner be treated for bacterial vaginosis (BV) only if the woman has recurring BV, or anytime a woman has BV?

Treatment of Male Sex Partners for Bacterial Vaginosis

Treatment of male sex partners is not recommended for routine cases of bacterial vaginosis (BV) but should be considered for women with recurrent BV based on recent evidence. 1

Standard Approach for BV Treatment

• BV is characterized by replacement of normal vaginal flora with anaerobic bacteria, affecting up to one-third of reproductive-aged women globally 2, 3
• Treatment has traditionally been directed solely at women, with no recommendation for male partner treatment 4
• CDC guidelines have historically stated that "treatment of the male sex partner has not been beneficial in preventing the recurrence of BV" 4, 3
• The principal goal of BV therapy is to relieve vaginal symptoms and signs of infection in women, not to prevent transmission 2

Evidence for Male Partner Treatment in Recurrent BV

• A recent 2025 randomized controlled trial published in the New England Journal of Medicine found that concurrent male partner treatment significantly reduced BV recurrence rates 1
• In this trial, women whose male partners received combined oral metronidazole and topical clindamycin had a 35% recurrence rate compared to 63% in the standard care group 1
• This represents an absolute risk difference of -2.6 recurrences per person-year (95% CI, -4.0 to -1.2; P<0.001) 1
• The trial was stopped early by the data safety monitoring board because treatment of the woman only was inferior to treatment of both partners 1

Treatment Regimen for Male Partners When Indicated

• For male partners of women with recurrent BV, the recommended regimen includes:
  • Oral metronidazole 400 mg twice daily for 7 days 1, 5
  • 2% clindamycin cream applied topically to the penile skin twice daily for 7 days 1, 5
• Male partners should be advised to avoid alcohol during metronidazole treatment and for 24 hours afterward due to potential disulfiram-like reactions 2, 6

Important Clinical Considerations

• BV is associated with sexual activity, as women who have never been sexually active rarely develop BV 4, 3
• Up to 50% of women experience BV recurrence within 3 months after standard treatment 5
• Previous trials of male partner treatment had significant methodological flaws including suboptimal treatment regimens, poor adherence reporting, and limited power 7
• Men treated with metronidazole may experience side effects including nausea, headache, and metallic taste 1

Clinical Algorithm for Male Partner Treatment

1. For first episode of BV: Treat the woman only with standard regimens (oral metronidazole or clindamycin) 4, 6
2. For recurrent BV (defined as ≥3 episodes in 12 months): Consider concurrent male partner treatment with combined oral and topical antimicrobial therapy 1, 5
3. Ensure both partners complete the full 7-day treatment course, as adherence appears to influence outcomes 8
4. Advise couples to abstain from unprotected sexual intercourse during the treatment period 5

Common Pitfalls to Avoid

• Treating male partners for first episodes of BV is unnecessary and exposes them to medication side effects without clear benefit 3, 6
• Failing to consider male partner treatment in cases of recurrent BV despite new evidence supporting its efficacy 1
• Not distinguishing BV from other conditions like trichomoniasis or vulvovaginal candidiasis, which have different treatment approaches 4, 2