A recent article in the New England Journal of Medicine suggests that treating male partners when women have bacterial vaginosis (BV) have a much higher success rate in preventing recurrence. This study was an open label randomized control trial in which Australian researchers randomized 164 pre-menopausal women with BV and their partners. There was a partner-treatment group where both men and women were treated, and the control group where women received first line treatment and their partners had no treatment. The primary outcome was recurrence of BV within 12 weeks. In the partner-treatment group the woman received anti-microbial medication and men received Metronidazole 400 mg tablets and 2% Clindamycin cream applied to the penile skin both twice daily for 7 days. The trial was stopped early after analysis showed that the 12 week recurrence rate in the woman-only treatment group was almost twice that in the both-partners treatment group (63% vs 35%).
Bacterial vaginosis is an imbalance of the vaginal microbiome in women. It is one of the most common causes of vaginal discharge affecting 1/3 of reproductive aged women. This dysbiosis is due to a deficiency of protective lactobacillus species and an overgrowth of anaerobic bacteria that changes the PH to a more alkaline state. It is associated with many adverse outcomes including an increased risk of adverse birth outcomes, acquisition of human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs), and pelvic inflammatory disease. Symptomatic recurrence after treatment can be as high as 60% in 1 year. Also, about 50% of women with BV are asymptomatic.
Breakthroughs have been made in the prevention of recurrent BV through specific oral probiotics for women to modulate the vaginal microbiome.
Breakthroughs have been made in the prevention of recurrent BV through specific oral probiotics for women to modulate the vaginal microbiome. This is used as adjunctive therapy to antibiotics (not instead of) to prevent BV recurrence. These probiotics feature clinically effective lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 strains. Some products also use a bovine lactoferrin with these bacterial strains which can increase the lactobacillus and decrease pathogen bacteria associated with BV. These probiotics can be safely used daily to help prevent BV or they can be administered for 10 days per month starting with the 1st day of the menstrual period which is a common time that BV can occur due to changes in vaginal PH.
I would be remiss if I didn’t also describe other causes of BV besides transmission from a partner, multiple partners or no condom use. Women can have BV even if they’re not sexually active. Other causes can be douches, vaginal deodorants (Please No deodorant sprays!!), scented soups and bubble baths. Also frequent antibiotic use, smoking and having an IUD with irregular bleeding. Excess stress and poor diet also put women at higher risk due to the changes in our vaginal and gut flora with the increase in stress hormones and weakened immune response. I also find these conditions more often in peri-menopausal and menopausal women. The vaginal PH changes with declining estrogen making the vagina a conducive environment for bacterial overgrowth.
References: Vodstrcil, L, et al. Male-Partner Treatment to Prevent Recurrence of Bacterial Vaginosis. The New England Journal of Medicine. March 5,2025. N Engl J Med 2025;392:947-957. DOI Male-Partner Treatment to Prevent Recurrence of Bacterial Vaginosis
Rajalakshmi, R. Kalaivani, S. Prevalence of asymptomatic infections in sexually transmitted diseases attendees diagnosed with bacterial vaginosis, vaginal candidiasis, and trichomoniasis. NIH. 2016 Jul-Dec;37(2):139–142.
Russo, R, Karadja, E et al. Evidence-based mixture containing Lactobacillus strains and lactoferrin to prevent recurrent bacterial vaginosis: a double blind, placebo controlled, randomized clinical trial. Beneficial Microbes, 2019; 10(1): 19-26.
Cool Springs OB/GYN. Why you keep getting bacterial vaginosis (BV). Womens Health. Dec 14th 2022.