Recurrent BV: Should the Male Partner Be Treated?

New evidence shows that treating a male partner with oral metronidazole and topical clindamycin may reduce recurrent BV. Learn who may benefit and what treatment involves.

GENERAL CARE

Sarina Helton, FNP, MSN, CAE-OM

8/27/20265 min read

When BV Keeps Coming Back: Should the Male Partner Be Treated?

New evidence may help couples break the cycle of recurrent bacterial vaginosis

Bacterial vaginosis—usually called BV—is one of the most common vaginal conditions. Unfortunately, it is also known for returning after treatment.

For years, standard guidance stated that male sexual partners did not need treatment. New research has changed that conversation. For women with recurrent, symptomatic BV, treating a regular male partner at the same time may significantly reduce the risk of another recurrence.

What Is Bacterial Vaginosis?

BV occurs when the normal balance of bacteria in the vagina changes. Protective Lactobacillus bacteria decrease, allowing other bacteria to become more abundant.

Symptoms may include:

Thin white or gray vaginal discharge
A strong or “fishy” vaginal odor
Burning, itching, or irritation
Burning with urination

Some women have no symptoms.

BV is not traditionally classified as a sexually transmitted infection. However, sexual activity can influence the vaginal microbiome, and BV-associated bacteria may be exchanged between sexual partners.

BV is not caused by poor hygiene, being “unclean,” or personal failure.

Why Does BV Keep Returning?

Antibiotics can treat the current bacterial imbalance, but they do not always prevent another episode. Recurrence may be influenced by:

Persistence of a bacterial biofilm
Difficulty restoring protective vaginal bacteria
Sexual exchange of BV-associated bacteria
A new sexual partner
Exposure to semen
Douching or the use of irritating vaginal products
Incomplete treatment
Other vaginal infections or an incorrect initial diagnosis

Recurrent symptoms should not automatically be assumed to be BV. Yeast infections, trichomoniasis, sexually transmitted infections, and other vaginal conditions can produce similar symptoms.

What Has Changed About Male-Partner Treatment?

A 2025 randomized controlled trial published in The New England Journal of Medicine evaluated couples in which the female partner had symptomatic BV and a regular male partner.

All female participants received standard BV treatment. In one group, the male partners also received:

Oral metronidazole twice daily for 7 days
Clindamycin 2% cream applied to the penile skin twice daily for 7 days

BV returned within 12 weeks in approximately:

35% of women whose male partners were treated
63% of women whose male partners were not treated

The trial was stopped early because treating only the female partner was clearly less effective.

Following this evidence, the American College of Obstetricians and Gynecologists updated its guidance. Concurrent partner treatment may now be offered to male partners of adults with recurrent, symptomatic BV. Shared decision-making may also be considered in some patients experiencing an initial symptomatic episode.

Does This Mean BV Is an STI?

Not exactly.

BV is still best understood as an imbalance in the vaginal microbiome rather than a single infection caused by one organism. However, growing evidence shows that BV-associated bacteria can be shared between sexual partners and may contribute to recurrence.

This does not indicate infidelity, and it does not mean that either partner has done anything wrong.

Does the Male Partner Need Testing?

There is no routine test used to diagnose BV in a man. Male partners often never have symptoms.

A man who has penile discharge, genital sores, rash, burning with urination, testicular pain, pelvic pain, or other genital or urinary symptoms needs a separate evaluation. These symptoms are not typical of BV-associated bacteria and may indicate an STI or another medical condition.

Testing for common STIs may also be appropriate based on each partner’s sexual history and risk factors.

What Treatment Is Used for the Male Partner?

A commonly used U.S.-adapted regimen is:

Metronidazole 500 mg by mouth twice daily for 7 days
Clindamycin phosphate vaginal cream 2% applied to the penile skin twice daily for 7 days

The clindamycin cream is applied in a thin layer to:

The head of the penis
Beneath the foreskin, if present
The groove below the head
The entire penile shaft down to the base

Although the product is labeled as a vaginal cream, its application to penile skin for BV partner treatment is an evidence-supported, off-label use.

Oral metronidazole alone has not consistently prevented BV recurrence. The newer evidence supports using both oral metronidazole and topical clindamycin.

Treatment must be prescribed after reviewing allergies, medications, medical history, and potential contraindications.

Why Should Both Partners Be Treated Together?

Treatment should be coordinated so both partners begin and complete their medication courses at approximately the same time. Treating only one partner may allow BV-associated bacteria to be exchanged again before treatment is complete.

Couples should avoid sexual contact until both partners have finished treatment. If sexual activity occurs, barrier protection is recommended.

Clindamycin cream can weaken latex condoms and diaphragms during treatment and for several days after the final application. Patients should review the specific product instructions and ask their healthcare provider or pharmacist about alternative protection.

Possible Side Effects

Oral metronidazole may cause:

Nausea
Abdominal discomfort
Metallic taste
Headache
Diarrhea
Darkened urine

Topical clindamycin may cause:

Penile redness
Burning
Itching
Skin irritation

Patients should seek urgent medical attention for facial or throat swelling, difficulty breathing, a severe or blistering rash, or other signs of a serious allergic reaction.

Contact a healthcare provider for persistent watery or bloody diarrhea, severe abdominal pain, or new numbness or tingling.

Patients should avoid alcohol while taking metronidazole and for at least three days after the final dose, consistent with current medication labeling.

Who May Not Be a Good Candidate?

Partner treatment may not be appropriate for someone with:

An allergy to metronidazole, tinidazole, clindamycin, or lincomycin
A history of C. difficile infection or severe antibiotic-associated colitis
Cockayne syndrome
Certain significant liver or neurologic conditions
A recent history of disulfiram use
A clinically significant medication interaction

A healthcare provider should review all prescription medications, over-the-counter products, and supplements before prescribing treatment.

Will Treating the Male Partner Guarantee That BV Will Not Return?

No. Concurrent treatment reduced recurrence substantially in the clinical trial, but approximately one-third of women still experienced another episode within 12 weeks.

Some patients may need:

Confirmation that the symptoms are truly caused by BV
STI testing
A different antibiotic regimen
Longer-term suppressive treatment
Evaluation for other vaginal conditions
Referral to a gynecology or sexual-health specialist

Partner treatment is a promising tool, but it is not a guaranteed cure.

The Bottom Line

When BV repeatedly returns, the problem may involve both partners—not because either person is unclean or has done something wrong, but because BV-associated bacteria may be exchanged during sexual activity.

New evidence supports treating a regular male partner with both oral and topical antibiotics while the female partner receives treatment. Coordinating treatment and completing every dose may help reduce the cycle of recurrence.

Treatment must be individualized and prescribed by a qualified healthcare professional.

For Women Experiencing Recurrent BV

If BV keeps returning, talk with your healthcare provider and your regular male partner about concurrent partner treatment. Both partners should be evaluated and, when appropriate, treated at approximately the same time.

[Start Your BV Evaluation]

Or visit Optima Vida Healthcare

For Male Partners

If your female partner has recurrent, clinician-diagnosed BV, you may be eligible for concurrent partner treatment. Complete our brief online health questionnaire for review by a licensed healthcare provider.

[Start the Male Partner BV Evaluation]

Or visit Optima Vida Healthcare

Treatment and prescriptions are provided only when medically appropriate and are not guaranteed.

References

Vodstrcil LA, Plummer EL, Fairley CK, et al. Male-Partner Treatment to Prevent Recurrence of Bacterial Vaginosis. N Engl J Med. 2025;392:947–957. https://doi.org/10.1056/NEJMoa2405404
American College of Obstetricians and Gynecologists. Concurrent Sexual Partner Therapy to Prevent Bacterial Vaginosis Recurrence. Clinical Practice Update. 2025. ACOG clinical guidance
New York State Department of Health AIDS Institute. Partner Treatment to Prevent Recurrent Bacterial Vaginosis. Clinical guidance
Centers for Disease Control and Prevention. About Bacterial Vaginosis. CDC patient information

Medical Disclaimer

This article is for general educational purposes and does not establish a patient-provider relationship or replace individualized medical care. Diagnosis and treatment decisions should be made by a licensed healthcare professional after reviewing the patient’s symptoms, medical history, medications, allergies, and applicable state requirements.

Contact

Optima Vida Healthcare, LLC
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support@ovhmed.com