Influence of male-partner antimicrobial therapy on bacterial vaginosis recurrence

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Created On: 06/11/2025

Bacterial vaginosis (bacterial overgrowth in the vagina) affects around 1 in 3 women of reproductive age and is notorious for its high recurrence rate.

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Key take away

Including both oral and topical antimicrobial treatment for male partners alongside standard therapy for women markedly lowers bacterial vaginosis recurrence within 12 weeks compared to treating only the women.

Background

Bacterial vaginosis (bacterial overgrowth in the vagina) affects around 1 in 3 women of reproductive age and is notorious for its high recurrence rate. Emerging evidence suggests that the bacteria linked with vaginal infection are capable of spreading between partners during sexual activity. Hence, this study explored male-partner treatment as a strategy to prevent the recurrence of bacterial vaginosis.

Method

In this randomized controlled trial, heterosexual couples were recruited in which the woman had bacterial vaginosis and was in a monogamous relationship. All women received standard first-line antimicrobial therapy. In the intervention group, male partners received a 7-day regimen of oral metronidazole (400 mg twice daily) along with topical application of 2% clindamycin cream to the penile skin twice daily. In the control group, male partners received no medical management. The primary outcome was bacterial vaginosis recurrence in women within 12 weeks.

Result

A total of 164 couples were randomized (81 to partner treatment, 83 to control). The trial was stopped early after 150 couples completed follow-up, as recurrence was markedly lower when both partners were treated. In the modified intention-to-treat analysis, the recurrence of bacterial vaginosis and recurrence rate per person-year was less in the partner-treatment group when compared to the control group (absolute risk difference: –2.6 recurrences per person-year; 95% confidence interval [CI], –4.0 to –1.2).

Reported side effects among treated men were mild and included headache, nausea, and metallic taste.

Conclusion

Treating both members of a couple—rather than the woman alone—substantially curtails the risk of bacterial vaginosis recurrence over 12 weeks. These findings highlight partner therapy as a promising approach for breaking the cycle of recurrent bacterial vaginosis.