What is the recommended treatment for a partner of someone with bacterial vaginitis?

Partner Treatment for Bacterial Vaginosis

Routine treatment of male sex partners is NOT recommended for bacterial vaginosis, as established guidelines and clinical trials consistently demonstrate no benefit in preventing recurrence or improving treatment outcomes in the female partner. 1, 2

Evidence-Based Recommendation

Standard of Care (Until 2025)

• The CDC guidelines explicitly state that clinical trial results show a woman's response to therapy and likelihood of relapse or recurrence are not affected by treatment of her sex partner(s). 1
• Multiple guideline sources confirm that routine partner treatment should not be performed. 2, 3
• This recommendation has remained consistent across treatment guidelines for both initial and recurrent bacterial vaginosis. 3, 4

Critical New Evidence (2025)

However, a landmark 2025 randomized controlled trial published in the New England Journal of Medicine directly contradicts decades of guideline recommendations and demonstrates significant benefit from male partner treatment. 5

Key Trial Findings:

• Male partners received combined oral metronidazole 400 mg twice daily PLUS topical 2% clindamycin cream to penile skin twice daily for 7 days. 5
• Recurrence rate with partner treatment: 35% (1.6 per person-year) 5
• Recurrence rate without partner treatment: 63% (4.2 per person-year) 5
• Absolute risk reduction: 2.6 recurrences per person-year (P<0.001) 5
• The trial was stopped early by the data safety monitoring board because treating only the woman was clearly inferior. 5

Clinical Decision Algorithm

For Initial Bacterial Vaginosis:

• Do not treat the male partner as per current published guidelines. 1, 2
• Treat the woman with standard first-line therapy (metronidazole 500 mg orally twice daily for 7 days or intravaginal alternatives). 2

For Recurrent Bacterial Vaginosis:

• Consider treating the male partner with the regimen studied in the 2025 trial: metronidazole 400 mg orally twice daily PLUS 2% clindamycin cream applied to penile skin twice daily for 7 days. 5
• This represents the highest quality, most recent evidence specifically addressing partner treatment and demonstrates clear mortality/morbidity benefit through prevention of recurrent infection. 5

Important Caveats

Why Previous Guidelines Recommended Against Partner Treatment:

• Earlier clinical trials showed no benefit, likely because they used inadequate treatment regimens (oral therapy alone without topical penile treatment). 1, 4
• The 2025 trial is the first to use combined oral and topical antimicrobial therapy targeting penile colonization. 5

Partner Treatment Side Effects:

• Male partners may experience nausea, headache, and metallic taste from metronidazole. 5
• Partners must avoid alcohol during treatment and for 24 hours after completion. 1, 2
• Clindamycin cream is oil-based and may weaken latex condoms. 2

Practical Considerations:

• Partner treatment is most justified in monogamous relationships where recurrence has already occurred. 5
• The woman should still receive standard first-line treatment regardless of partner treatment decision. 2, 5
• This new evidence has not yet been incorporated into formal guidelines, but represents the strongest available data on this question. 5