Treatment of Male Partners in Bacterial Vaginosis
Male partners of women with bacterial vaginosis should NOT routinely receive treatment, as multiple clinical trials have consistently shown that partner treatment does not improve cure rates or reduce recurrence in women. 1, 2
Standard Recommendation: No Partner Treatment
The Centers for Disease Control and Prevention explicitly states that routine treatment of male sex partners is not recommended, as clinical trials demonstrate that a woman's response to therapy and likelihood of relapse are not affected by treatment of her partner(s). 1
This recommendation has remained consistent across multiple guideline iterations and is supported by decades of clinical trial data. 3, 4
Male partners typically do not have symptoms of bacterial vaginosis-associated organisms, and treating asymptomatic men does not provide clinical benefit to their female partners. 1
Recent Contradictory Evidence
However, a 2025 randomized controlled trial challenges this longstanding recommendation:
A recent Australian trial found that combined oral metronidazole 400 mg twice daily PLUS topical 2% clindamycin cream applied to penile skin twice daily for 7 days in male partners resulted in significantly lower recurrence rates in women (35% vs 63%, absolute risk difference -2.6 recurrences per person-year, P<0.001). 5
This trial was stopped early by the data safety monitoring board because treatment of the woman alone was inferior to treatment of both partners. 5
The regimen used was: metronidazole 400 mg tablets orally twice daily for 7 days PLUS 2% clindamycin cream applied to penile skin twice daily for 7 days. 5
Clinical Decision Algorithm
Given the conflicting evidence, here is a practical approach:
For Initial Episodes of BV:
- Do NOT treat the male partner - follow current CDC guidelines, as the 2025 trial focused on recurrent BV, not initial episodes. 1
For Recurrent BV (≥2 episodes):
Consider treating the male partner with the combination regimen from the 2025 trial: metronidazole 400 mg orally twice daily PLUS 2% clindamycin cream to penile skin twice daily, both for 7 days. 5
Counsel the male partner about expected adverse effects: nausea, headache, and metallic taste. 5
Instruct complete alcohol avoidance during metronidazole treatment and for 24 hours after the last dose to prevent disulfiram-like reactions. 1
Advise the couple to refrain from unprotected intercourse for at least 14 days during treatment. 6
Important Caveats
The 2025 trial used a combination of oral AND topical therapy for men - this is not the same as oral metronidazole alone, which has been studied previously without benefit. 5
Earlier studies using only oral metronidazole for male partners showed conflicting results, with some showing initial benefit but no sustained reduction in recurrence. 7, 6
The 2025 trial has not yet been incorporated into CDC guidelines, which still recommend against partner treatment as of 2026. 1
Adherence to the male partner regimen appears critical - women whose partners adhered to medication were less likely to fail treatment. 6
What NOT to Do
Do not prescribe metronidazole alone for male partners without the topical clindamycin component, as this approach has not been shown to reduce recurrence in most studies. 1, 6
Do not treat male partners for initial BV episodes - reserve this approach only for recurrent cases if you choose to implement the 2025 trial findings. 5
Do not use clindamycin cream alone for male partners - the successful regimen requires both oral metronidazole AND topical clindamycin. 5