A new study is making waves in the medical community by suggesting that treating men, not just women, might be the best way to finally stop bacterial vaginosis (BV) from coming back. This idea could change the way doctors think about this common infection, which affects about one in three women.
What Is Bacterial Vaginosis?
Bacterial vaginosis is a condition caused by an imbalance of bacteria in the vagina. When healthy bacteria are overwhelmed by other kinds of bacteria, women can experience a thin, green-gray discharge, a strong fishy odor, and sometimes a burning feeling while peeing or vaginal itching. But not all women have symptoms. In fact, studies show that “at least half of women with bacterial vaginosis don’t have symptoms.”
Dr. Denise Millstine from the Mayo Clinic explains, “Typically, what people experience when they have BV, or bacterial vaginosis, is an odorous discharge. Often it will be described as a fishy odor.” Unlike yeast infections, BV usually causes less irritation and a thinner discharge.
While BV is not officially considered a sexually transmitted infection (STI), the Centers for Disease Control and Prevention (CDC) says that sexual activity is one of the risk factors. BV can also increase the risk of getting other STIs like chlamydia or HIV, as well as leading to pelvic inflammatory disease. In pregnant women, BV can increase the risk of premature birth.
Why Treatment Fails for Many Women
The standard treatment for BV is a weeklong course of antibiotics, usually metronidazole, which can be taken as a pill or used as a vaginal gel. While this works for many women at first, the infection often comes back. Dr. Paul Nyirjesy, co-director of the Jefferson Vulvovaginal Health Center, says, “Its high recurrence rate means patients have to get treated over and over and over — five, six, 10 times,” which can be frustrating and affect their quality of life and sex lives. Even long-term treatment does not always stop BV from returning.ChatGPT said:
The most commonly used antibiotic is metronidazole, which can be taken as a pill or applied as a vaginal gel, and sometimes clindamycin is used as a cream or pill. While this treatment usually clears up the infection, it has some downsides. Many women experience a metallic taste in their mouth while taking metronidazole, and they have to avoid all alcohol because it can cause severe nausea and other reactions. Unfortunately, even after this treatment, BV often comes back within a few months, leading to frustration and repeated rounds of antibiotics. This new study suggests that treating male partners at the same time might finally stop these endless cycles of treatment.
Another problem with antibiotics is that they can cause unpleasant side effects. Dr. Millstine explains, “For almost everybody, it gives them an odd metallic taste in their mouth.” Drinking even small amounts of alcohol while on metronidazole can make you very sick, with symptoms like nausea, vomiting, and stomach cramps.
A New Study Changes Everything
A recent study published in the New England Journal of Medicine found that treating women’s male partners can dramatically lower the chances of BV returning. Researchers in Australia enrolled 164 couples where the women had BV and were in monogamous relationships. Half of the couples only had the woman take antibiotics, while the other half had both the woman and her male partner take antibiotics and use a topical antibiotic cream.
The results were striking. After 12 weeks, only 35 percent of women whose partners were also treated had BV again. In comparison, 63 percent of women whose partners were not treated had a recurrence of BV. “The study was stopped early because the benefit of treating both women and their partners was so clear,” said researchers.
Dr. Jillian LoPiano, an OB-GYN and the Chief Medical Director at Wisp, said the research confirms what many doctors have believed for years. “We’ve been talking about the same thing for years, but in the absence of good data, we weren’t making any interventions,” she said. “This illustrates that when you actually do quality studies in the area of women’s health, impactful interventions can be made.”
Dr. Christina Muzny, professor of obstetrics and gynecology at the University of Alabama at Birmingham, agrees. She said, “Not only do the study results change how BV could be treated going forward, but they also seem to confirm a long-held suspicion among scientists that the condition is actually a sexually transmitted infection.” Dr. Muzny believes that “patients and providers are going to need renewed education on BV” to understand this new approach.
How Men Play a Role
Doctors have long suspected that bacteria from a male partner could be part of the problem. According to Dr. Millstine, “It has been proposed for many years that something about the vaginal flora — the combination of the organisms for women — is altered from having penetrative sex.” Although men do not get BV themselves, the bacteria on their penis and urethra can upset the natural balance in the vagina and trigger BV.
This idea was supported by UR Medicine experts Dr. Erin Duecy and Dr. Joseph Panza. They explained, “We don’t know if the increase in recurrent BV is because sexual partners are passing certain bacteria that are more likely to cause bacterial vaginosis, or if the normal bacteria exchanged during sex disrupts the bacterial balance in the vagina, allowing species like Gardnerella — the bacteria responsible for BV — to overgrow.”
A New Option for Women
For many women, this study brings hope. Dr. Millstine said, “It’s a relatively small study, but it did make quite a splash. For many women, bacterial vaginosis is such a thorn in their side, so frustrating when it keeps coming back.” She added, “The study’s findings offer a new option, especially for women in monogamous relationships who have recurrent BV.”
Wisp, a telehealth service that provides reproductive health care, is already offering partner treatment for BV. Wisp CEO Monica Cepak said, “This is a huge breakthrough in BV care, because for so long, we’ve had a higher rate of recurrence, and now we have a reason why and can easily treat it.”
Dr. LoPiano from Wisp added, “Tons of women are suffering with this. While it may not be a deadly disease, it’s impactful on the quality of women’s lives, comfort, sex lives and relationships. And I think that shouldn’t be underestimated. That makes this a big deal.”
What Should You Do?
If you have symptoms of BV — like an unusual discharge, fishy odor, or discomfort — it is a good idea to see your healthcare provider. A simple pelvic exam and swab test can confirm if you have BV. If you keep getting BV and you are in a monogamous relationship, it may be worth asking your doctor about treating your partner as well.
As Dr. Millstine reminds us, “There can be so many variations of normal with discharge. But sometimes, it is indicative of a medical condition like BV or an infection. And we do often have treatment strategies that might help women feel better, faster.”
This new research is giving women a chance to finally break the cycle of BV. If you are tired of repeated infections, talk to your healthcare provider about the possibility of partner treatment. This new approach could be the key to stopping BV once and for all.
