Treat the Male Partner to Prevent Recurrence of BV?

Written by Vivian Lei

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Treating male partners with oral and topical antimicrobials alongside women with bacterial vaginosis significantly reduced recurrence rates at 12 weeks.

Beating BV – it takes two
Bacterial vaginosis (BV) is a common and recurrent condition, affecting about one in three reproductive-aged women worldwide. Despite standard treatment with metronidazole or clindamycin, recurrence rates within just 3 months can exceed 50%. Prior data suggest that BV behaves like a sexually transmitted infection, but past studies treating male partners did not show much benefit.

In the open-label StepUp trial, a multicenter randomized controlled study published in NEJM, Australian researchers enrolled 164 heterosexual, monogamous couples in which the woman had symptomatic BV. All women received standard antimicrobial therapy. In the intervention group, male partners were also treated with a 7-day course of oral metronidazole and topical 2% clindamycin cream applied to the penis. In the control group, women received standard care, with no treatment for male partners.
The trial was stopped early when an interim analysis showed BV recurrence within 12 weeks occurred in only 35% of women in the partner-treatment group, compared to 63% in the control group. The intervention was generally well-tolerated, with mild adverse effects reported among men, such as nausea and headache. Adherence among male partners was good, and recurrence rates were lowest when adherence was highest.

How will this change my practice?
It is a disservice to our patients to treat BV as just a vaginal dysbiosis when it appears to act like a sexually transmitted infection. This study strongly suggests that reinfection from untreated male partners is a major contributor to recurrence. I plan to start counseling patients on the potential for reinfection and encouraging follow-up for both partners.

Source
Male-Partner Treatment to Prevent Recurrence of Bacterial Vaginosis. N Engl J Med. 2025 Mar 6;392(10):947-957. doi: 10.1056/NEJMoa2405404. PMID: 40043236