Treatment of Male Partners Exposed to Bacterial Vaginosis
No, male partners of women with bacterial vaginosis do not require treatment. This is the clear and consistent recommendation from the CDC and ACOG guidelines, supported by decades of evidence showing no benefit to partner treatment. 1, 2, 3
The Evidence Against Male Partner Treatment
Guideline Consensus
- Treatment of male sexual partners has consistently failed to prevent BV recurrence in women, according to multiple CDC guidelines spanning decades. 3
- The CDC explicitly states that treating male sex partners has not been found beneficial in preventing the recurrence of BV in women. 2
- Male partners are not symptomatic even when carrying BV-associated bacteria, and treating them does not alter the clinical course of BV during treatment or reduce relapse rates. 3
High-Quality Systematic Review Evidence
- A 2016 Cochrane systematic review of 7 randomized controlled trials (1,026 participants) found high-quality evidence that antibiotic treatment of male partners does not increase clinical or symptomatic improvement in women at any time point (first week, 1-4 weeks, or after 4 weeks). 4
- The same review found that partner treatment does not reduce recurrence rates but does increase adverse events in men (primarily gastrointestinal symptoms) with a risk ratio of 2.55. 4
Why This Recommendation Exists
BV Is Not a Classic STI
- While BV is associated with sexual activity (women who have never been sexually active rarely develop BV), it is not considered a classic sexually transmitted infection. 3
- The association with multiple sex partners does not necessarily mean acquisition of a sexually transmitted pathogen. 3
The Primary Treatment Goal
- The principal goal of BV therapy is to relieve vaginal symptoms and signs in women, not to prevent transmission to men. 2
- Preventing transmission to men has historically not been considered a goal of therapy. 2
Important Caveats and Emerging Evidence
Methodological Concerns with Older Studies
- A 2012 systematic review noted that the 6 original RCTs of male partner treatment had significant methodological flaws, including deficient randomization methods, suboptimal treatment regimens in women, unreported adherence rates, and limited statistical power. 5
- None of these trials assessed whether antibiotic treatment actually affected the penile microbiota. 5
Recent Pilot Study Findings
- A 2021 pilot study of 34 couples using combined oral and topical treatment in male partners showed promising microbiological changes, with only 17% recurrence at 12 weeks (compared to expected 50%). 6
- However, this was a small, uncontrolled pilot study without a comparison group, and does not override current guideline recommendations. 6
- This study suggests the need for future randomized controlled trials but is insufficient to change current practice. 6
Clinical Bottom Line
Do not routinely treat male partners of women with BV. 1, 2, 3 The consistent guideline recommendation is based on multiple trials showing no benefit and potential harm (increased adverse events in men). 4 While emerging research suggests this area may warrant further investigation, current evidence-based practice clearly indicates that partner treatment is not beneficial. 1, 2, 3