#403 A Whiff of Prevention: Treating Male Partners to Reduce Bacterial Vaginosis Recurrence
CLINICAL QUESTION
Does treating male sexual partners of females undergoing treatment for bacterial vaginosis infection decrease recurrence?
BOTTOM LINE
For women undergoing bacterial vaginosis treatment, simultaneously treating male partners with metronidazole alone is ineffective. However, treating male partners with a combination of topical clindamycin and oral metronidazole may reduce the rate of bacterial vaginosis recurrence to 35% from 63% (no treatment) at 12 weeks based on 1 randomized, controlled trial (RCT). Considering the limited harms, this combination may be reasonable in male partners.
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EVIDENCE
- Results statistically different unless stated.
- Two newer, higher-quality Most females received oral metronidazole 400-500mg twice daily for 7 days:
- Open-label RCT (164 couples, 87% previous bacterial vaginosis, monogamous relationship ~14 months). 1 Partners given oral metronidazole 400mg and clindamycin 2% cream twice daily for 7 days, or no treatment.
- Recurrence at 12 weeks: 35% versus 63% (control), Number Needed To Treat=4
- Mean time to recurrence: 74 days versus 55 days (control).
- Adverse events, males:
- Oral: Nausea (14%), headache (12%), metallic taste (7%).
- Topical: Penile redness (4%) and irritation (7%).
- Control arm not reported.
- Stopped early for benefit (may overestimate benefit).
- Double-blind RCT (214 females with ≥2 infections in past year, 14-18% had ≥2 partners in previous 3 months).² Partners given oral metronidazole or placebo for 7 days. At 16 weeks:
- Treatment failure: No difference.
- Adverse events: No difference.
- Stopped early for futility.
- Older systematic review, 7 RCT (1026 participants), partners treated with oral antibiotics alone: no effect.3 Limitations include some non-standard treatments (example: oral metronidazole 2g single dose).
CONTEXT
- Clindamycin cream applied to glans penis, upper shaft and under foreskin (if uncircumcised).1
- Guidelines recommend:4,5
- In females: Metronidazole 500mg orally twice daily or clindamycin 2% vaginal cream daily for 7 days; or metronidazole 0.75% vaginal gel daily for 5 days.
- Partner treatment not currently recommended.
- Oral and vaginal regimens are similarly effective; oral metronidazole has more gastrointestinal side effects.6,7
- Cost (7 days):8
- Oral: Metronidazole 500mg $28.
- Vaginal: Clindamycin 2% cream $65; metronidazole 0.75% gel $44.
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