April 2025
Bacterial vaginosis: study of male-partner treatment ‘a game changer’
By Rebecca Jenkins
Treating both the male and female partners in a couple when the woman has bacterial vaginosis (BV) significantly reduces recurrence of the condition, compared with only treating the affected woman, Australian research finds.
Current international guidelines recommend using metronidazole or clindamycin as first-line treatment for women with BV, a dysbiosis of the vaginal microbiota which affects 30% of reproductive age women worldwide.
Writing in The New England Journal of Medicine, the study authors, who were led by researchers from Melbourne Sexual Health Centre, a department of Monash University and Alfred Health, Melbourne, said this strategy was not a sustained cure, with recurrence rates exceeding 50% within three months.
In an open-label, randomised, controlled trial, researchers enrolled 164 couples where the woman had BV and was in a monogamous relationship with a male partner.
There were two study arms, a control group and a partner-treated group, with women in both groups receiving first-line recommended antimicrobial treatment. However, in the partner-treatment group, the male received metronidazole 400 mg tablets and 2% clindamycin cream applied to penile skin, both twice daily for seven days, whereas men in the control group received no treatment.
In an intention-to-treat analysis of 137 couples, BV recurrence at 12 weeks was documented in 24 of 69 women (35%) in the partner-treatment group (recurrence rate of 1.6 per person-year) compared with 43 of 68 women (63%) in the control group (recurrence rate of 4.2 per person-year).
These rates corresponded to an absolute difference of −2.6 recurrences per person-year, the authors reported.
‘Unlike previous trials of male-partner treatment, which used only oral antimicrobial therapy, our trial targeted male carriage bacterial vaginosisassociated organisms at both the penile urethra and penile skin, including the subpreputial space,’ the authors wrote.
Dr Terri Foran, Sexual Health Physician and Senior Lecturer in the School of Women’s and Children’s Health at UNSW Sydney, said the study was a game changer, adding that she expected the treatment strategy to become incorporated into BV treatment guidelines for patients who were in ongoing relationships.
‘This paper makes a real difference to the advice we can now give to our female patients and, in particular, to those who are troubled by recurrent BV,’ she said.
Dr Foran predicted the challenge for both women and clinicians would be persuading a male partner, who has no symptoms, to commit to a slightly more complicated treatment than that prescribed to their female partner.
‘Access to comprehensive, easy-to-understand information sheets in both English and community languages should help to facilitate this, as in most cases it will be the woman and not the couple presenting for treatment,’ she said.
‘The ability to provide expedited scripts for partners as we currently can do in most states for uncomplicated chlamydia treatment would also be useful here.’
The next research challenge for BV was to establish the still elusive causative organism or organisms, which might allow for even more targeted treatment.
‘Hopefully, the growing use of more sophisticated DNA-based detection methods should be able to assist in further unravelling this mystery,’ Dr Foran said.
Melbourne Sexual Health Centre has changed its clinical practice to offer treatment to the male partners of women with recurrent BV in ongoing relationships and has produced a website for clinicians with further information about the strategy (https://www.mshc.org.au/health-professionals/bv-health-professional-info/clinician-instructions-for-bv-partner-treatment).