Male-Partner Treatment to Prevent Recurrence of Bacterial Vaginosis - Article Summary

Summary Author: Marietta Kocher

Brief Summary:

Bacterial vaginosis (BV) affects 30% of reproductive-aged women. Treatment guidelines recommend metronidazole or clindamycin as first-line treatment; however, the incidence of recurrence within 3 months is greater than 50%. Studies have shown than men can harbor bacteria that are associated with BV and the penile microbiota is predictive of their partner’s risk of BV. Previous studies that examined male-partner treatment were limited by several factors, including assessment of oral antibiotics alone. This trial addresses these limitations by comparing male-partner treatment with oral and topical antibiotics to treatment of the woman alone.

Study Design:

This study is a randomized controlled trial. Eligible participants were premenopausal women with symptoms of BV, meeting the diagnostic criteria (using Amsel criteria and Nugent score), who had a regular male partner for at least 8 weeks before enrollment and were receiving BV treatment. Randomization was stratified by recruitment site, current IUD use, and male circumcision status. They were randomly assigned to the partner-treatment group or the control group (treatment of the woman only). Male partners assigned to treatment were given oral metronidazole and topical clindamycin. Questionnaires and vaginal samples were collected at baseline, day 8, and weeks 4, 8, & 12. The primary outcome was the recurrence of BV. 69 couples in the partner-treatment group and 68 couples in the control group were included in the primary analysis.

Findings:

Primary Outcome: BV recurrence occurred in 35% of the partner-treatment group (1.6 per person-year; 95% CI, 1.1 to 2.4) and 63% of the control group (4.2 per person-year; 95% CI, 3.2 to 5.7). Time to recurrent was shorter in the control group. There was a lower risk of recurrence in the partner-treatment group (hazard ratio 0.37; 95% CI, 0.22 to 0.61). There were no differences in treatment effect between groups when stratified by IUD use and circumcision status.

Limitations:

Participants were largely from one sexual health service, which may reflect a higher-risk population in limit the generalizability of these results. Additionally, only women in monogamous relationships were eligible. Some participants may not have disclosed concurrent partners.

Conclusions:

Treatment of male partners with oral metronidazole and topical clindamycin in addition to treatment of the female partner reduces the recurrence of BV when compared to treatment of the female patient alone.

Main Takeaway

Treating male partners with oral and topical antibiotics in addition to treating the female patients results in a lower incidence of recurrent bacterial vaginosis within 12 weeks.

References:

Vodstrcil LA, Plummer EL, Fairley CK, et al. Male-Partner Treatment to Prevent Recurrence of Bacterial Vaginosis. N Engl J Med. 2025; 392(10): 947-957. doi:10.1056/NEJMoa2405404