Long considered unique to women and a simple vaginal imbalance of healthy and unhealthy bacteria. Bacterial vaginosis is now recognized as sexually transmissible, and treating male partners can significantly reduce recurrence rates. A landmark randomized trial from Melbourne found:
- Partners treated with oral metronidazole + topical clindamycin cream during their partner’s treatment reduced female recurrence from ~63% to ~35% at 12 weeks—nearly halving relapse rates (Herald Sun, Melbourne Sexual Health Centre).
- The trial was halted early due to clear benefit, prompting updates in Australia’s Sexual Health Centre protocols (Herald Sun).
- A U.S. expert review echoed the findings: combined oral/topical treatment of male partners significantly improved outcomes versus treating women alone (Mayo Clinic Press).
Takeaway: For heterosexual couples with BV, treat both partners simultaneously to improve cure rates and reduce recurrence. In separate information there is data that confirms female to female transmission through sexual contact as well.
Ideal Partner Treatment Regimen
- Oral metronidazole 400 mg twice daily for 7 days
- Topical clindamycin 2% applied to the penis twice daily for 7 days
Studies report treatment is well tolerated with minimal side effects (CDC, Mayo Clinic Press).
Who Should Undergo STI Testing?
Treating male partners provides an opportunity to evaluate broader sexual health:
- Chlamydia & Gonorrhea: CDC recommends annual screening—especially in men with at-risk behaviors or partners with STIs (UpToDate, Wikipedia).
- HIV & Syphilis: Test according to risk factors and local epidemiology. It is now possible to get a home test for HPV, speak to your provider about whther this is for you.
- HPV Status & Vaccination:
- HPV affects both men and women and can lead to cancers of genital and oropharyngeal sites (Wikipedia).
- HPV vaccination is recommended up to age 26, and in some cases through age 45, particularly in high-risk individuals (Wikipedia).
- While not FDA-approved for BV prevention, HPV vaccination protects against genital warts and certain cancers.
Clinical Checklist for Male Partner Management in BV Cases
- ☐ Confirm female has BV and start treatment (oral/intravaginal antibiotics).
- ☐ Start male partner concurrently with oral + topical therapy.
- ☐ Offer STI testing (chlamydia, gonorrhea, HIV, syphilis).
- ☐ Review HPV vaccination status; administer or refer as appropriate.
- ☐ Discuss condom use until male partner completes treatment.
- ☐ Schedule follow-up to monitor for symptom resolution and recurrence.
Why This Matters
- Recurrence in BV affects >50% of women within 3 months when partners aren’t treated (Wikipedia, Herald Sun, CIDRAP).
- Untreated BV increases risk of PID, adverse pregnancy outcomes, chronic pelvic pain and susceptibility to STIs including HIV (Wikipedia).
- Partner treatment represents a simple, evidence-based intervention, with major benefits to women’s health and potentially long-term reproductive outcomes.
Summary
Emerging evidence supports updating practice:
- Treat a male or a female partner in addition to female with combined oral and topical antibiotics.
- Screen for STIs in male partners, offering HPV vaccination if eligible.
- This aligns with a couples-based approach, reframing BV as a shared infection, not just a female-only issue.
Implementing partner treatment and broader sexual health screening can end the cycle of BV recurrence—and improve outcomes for both patients.
