Can a female patient of reproductive age with Bacterial Vaginosis (BV) have sexual intercourse while being treated with antibiotics such as metronidazole (Flagyl) or clindamycin?

Sexual Activity During BV Treatment

You should avoid sexual intercourse during the entire course of BV treatment and ideally refrain from unprotected intercourse for at least 14 days to allow treatment to take full effect. 1

Key Recommendations

Abstinence During Treatment

• The CDC guidelines do not explicitly mandate sexual abstinence during BV treatment, but practical considerations strongly support this recommendation 2
• Patients should avoid sex until both they and their partners are cured (therapy completed and both are asymptomatic) 2
• Refraining from unprotected intercourse for at least 14 days allows treatment to take effect and reduces risk of reinfection 1

Important Medication Considerations

If using clindamycin cream:

• Clindamycin cream is oil-based and can weaken latex condoms and diaphragms, making barrier contraception unreliable during treatment 2
• This creates an additional safety concern for sexual activity during the 7-day treatment course 2

If using metronidazole:

• You must avoid all alcohol during treatment and for 24 hours after completion to prevent disulfiram-like reactions (flushing, nausea, vomiting, headache) 2, 1, 3, 4
• This applies to both oral and vaginal metronidazole formulations 2

Partner Treatment Considerations

Evidence Against Routine Partner Treatment

• The CDC explicitly states that routine treatment of sex partners is NOT recommended 2, 4
• Clinical trials demonstrate that a woman's response to therapy and likelihood of relapse or recurrence are not affected by treating her sexual partner(s) 2, 4, 5
• High-quality evidence shows antibiotic treatment of partners does not increase clinical or symptomatic improvement rates in women at any time point 5
• Partner treatment actually increases adverse events (primarily gastrointestinal symptoms) in partners without providing benefit 5

Exception in Newer Guidelines

• One newer guideline suggests treating male partners with metronidazole 400 mg orally twice daily for 7 days plus 2% clindamycin cream applied topically to penile skin twice daily for 7 days to reduce BV recurrence 1
• However, this contradicts the established CDC recommendations and high-quality Cochrane evidence showing no benefit 2, 5

Common Pitfalls to Avoid

Condom integrity: If you must have sex during treatment with clindamycin cream, understand that latex barrier methods may fail 2

Alcohol consumption: Even small amounts of alcohol can trigger severe reactions with metronidazole—this includes alcohol in mouthwash or medications 2, 1, 3, 4

Premature resumption of sex: Waiting until symptoms resolve is insufficient; complete the full treatment course first 2

Treatment Completion and Follow-Up

• Follow-up visits are unnecessary if symptoms resolve 2, 4
• Recurrence of BV is common (50-80% within one year), but this is not prevented by partner treatment 6, 7, 5
• If symptoms recur, return for re-evaluation and possible alternative treatment regimens 4