Treatment of Male Partners in Recurrent Bacterial Vaginosis
Male sexual partners of women with recurrent bacterial vaginosis should NOT be treated, as partner treatment has not been shown to prevent BV recurrence or alter the clinical course of the infection. 1
Evidence-Based Rationale
The CDC guidelines explicitly state that treatment of male sex partners has not been found beneficial in preventing the recurrence of BV. 1 This recommendation is based on the understanding that:
- BV is not considered exclusively a sexually transmitted disease, despite its association with sexual activity. 1
- Male partners are typically asymptomatic and do not harbor the polymicrobial biofilm characteristic of BV. 1
- Partner treatment does not alter either the clinical course of BV during treatment or the relapse/reinfection rate. 1
Why This Differs from Other Vaginal Infections
This recommendation contrasts sharply with vulvovaginal candidiasis (VVC), where partner treatment may be considered in recurrent cases, particularly if the male partner has symptomatic balanitis. 1 However, even for recurrent VVC, routine partner treatment remains controversial. 1
What Actually Works for Recurrent BV
Instead of treating partners, focus management on the affected woman:
Suppressive Therapy (CDC-Recommended)
- Twice-weekly metronidazole gel for 16 weeks after successful initial treatment reduces symptomatic BV recurrence. 2
- This approach is currently the CDC-recommended strategy for preventing recurrent BV. 2
Intensive Treatment Regimens for Refractory Cases
- Combination therapy with oral nitroimidazole plus prolonged boric acid (30 days) followed by maintenance metronidazole gel achieved long-term cure in approximately 69% of women with intractable recurrent BV. 3
- This represents a more aggressive approach when standard regimens fail. 3
Periodic Presumptive Treatment
- Regular administration of BV treatment regimens at intervals can reduce BV frequency by 10-45% over 12 months, regardless of symptoms. 2
Common Pitfall to Avoid
Do not waste time and resources treating male partners based on the assumption that BV behaves like a traditional STD. The microbial alteration in BV is not fully understood, and the condition does not respond to partner treatment strategies that work for infections like trichomoniasis or gonorrhea. 1 The high recurrence rate (up to 76% within 6 months) is related to biofilm formation, antimicrobial resistance, and vaginal microbiome dysbiosis—not reinfection from untreated partners. 4, 5