PathAdvantage | 07/29/2025What is Bacterial Vaginosis?
Bacterial vaginosis (BV) is a widespread vaginal infection, impacting roughly one in three women globally during their lifetime.
It is a serious illness, resulting from a disruption in the vaginal microbiome where healthy lactobacilli are overtaken by an overgrowth of other bacteria. It can trigger symptoms such as vaginal discharge, a strong fishy odor or vaginal discomfort and pain. But BV isn’t just unpleasant, it’s also linked to increased susceptibility to STIs and complications like preterm birth.
Although standard treatments like oral metronidazole and clindamycin can clear the infection initially, more than half of treated women experience a return of the infection. The persistent nature of BV has frustrated patients and their doctors, prompting them to seek more durable, long-term options.
Traditionally, only women have been treated for BV, not their male partners. Increasingly, though, strong research seems to indicate that untreated male partners may be responsible for the reintroduction of BV-related bacteria, contributing to reinfection. Recent findings from a study published in the New England Journal of Medicine support this and suggest a new approach to BV treatment.
New Findings
The researchers looked at whether treating male partners would affect the rate of recurrence of BV in women. The study followed 164 women in heterosexual relationships. All the women had been diagnosed with BV and treated with a standard round of antibiotics. In half of the couples, however, the male partners were also treated with a week-long course of oral metronidazole and topical clindamycin.
The differences between the two groups were stark. 63% of the group where only women were treated experienced a recurrence of BV within 12 weeks, compared to only 35% of the women in the group where the male partner was treated.
What does it mean for clinicians?
These results indicate a new approach to standard BV treatment — treating the women as well as the men. But this raises questions for clinical practice. Will women’s health-focused clinicians feel confident recommending treatment for male partners, and will these partners adhere to a regimen designed to benefit their partners’ health?
There is a precedent: Expedited Partner Therapy (EPT) is already an established approach for treating STIs. Applying a similar approach to BV may result in better outcomes. However, changing existing clinical practice rarely happens overnight or without difficulties. This may require more research, debate and time for acceptance. Still, the findings indicate a promising new approach for a stubborn infection that has previously frustrated doctors and their patients.
How does this finding impact women with same-sex partners?
Unfortunately, there are limited studies of BV in women who have sex with women, and more research is needed. However, there is some data that provides evidence that BV risk in women is related to exposure to other female partners and/or a partner with BV, providing support for the concept that BV is likely to be transmitted between women. And no one has studied the same treatment approach as the paper covered here in same-sex couples. Without more scientific data, we can’t conclusively say that treating both partners in same-sex relationships would be effective. However, it seems reasonable to conclude that would be the case.
SOURCES:
Vodstrcil LA, Plummer EL, Fairley CK, Hocking JS, Law MG, Petoumenos K, Bateson D, Murray GL, Donovan B, Chow EPF, Chen MY, Kaldor J, Bradshaw CS; StepUp Team. Male-Partner Treatment to Prevent Recurrence of Bacterial Vaginosis. N Engl J Med. 2025 Mar 6;392(10):947-957. doi: 10.1056/NEJMoa2405404.
Tobian AAR, Gray RH, Quinn TC. Male Circumcision for the Prevention of Acquisition and Transmission of Sexually Transmitted Infections: The Case for Neonatal Circumcision. Arch Pediatr Adolesc Med. 2010;164(1):78–84. doi:10.1001/archpediatrics.2009.232