Bacterial Vaginosis – The Importance of Male Partner Treatment

Bacterial vaginosis is a common sexual health condition primarily affecting women. While easily treatable with antibiotics, it doesn’t always cause symptoms and it has not always been well-understood. Achieving a cure has been challenging for some women, as relapse and recurrence are very common.

New research undertaken by the Melbourne Sexual Health Centre demonstrates that bacterial vaginosis is sexually transmissible – and this strongly indicates that treatment strategies must also include male partners of affected women.

What is Bacterial Vaginosis?

Bacterial vaginosis or BV is a bacterial infection caused by an imbalance of the vaginal bacteria. At normal levels, these bacteria keep the vagina healthy, but if too many or too few of some types grow, an imbalance occurs and this can result in BV.

BV can occur in women of any age.  It is most common during the reproductive years, due in part to the influence of hormones on the vaginal environment. 30% of women worldwide are affected by this condition, including at least 12% of non-Indigenous and 30% of Indigenous women in Australia. For more than 50% of those treated, recurrence of the condition will occur within 3-6 months of treatment.

Bacterial Vaginosis Symptoms

While as many as 50% of women with BV do not display symptoms, symptoms and signs may include:

• Vaginal discharge that is thin and white, grey, or green
• A foul, unpleasant vaginal odour (“fishy” smell)
• Vaginal/vulval itching or irritation
• Vaginal pain/discomfort
• Burning during urination

Bacterial Vaginosis Causes

Bacterial vaginosis is not always sexually acquired, however, most cases are related to sexual activity and acquiring BV is strongly linked with sexual behaviours that are also associated with sexually transmitted infections (STIs).

The condition risk is increased by:

• Young age at first sex
• Having multiple sexual partners over time
• Exposure to new sexual partners
• Penile-vaginal intercourse
• Failure to use condoms/unprotected sex
• Douching to clean the vagina
• When both sexual partners have vaginas
• Having a copper IUD
• Being a smoker/vaper

Bacterial vaginosis is diagnosed in women via medical/sexual history, clinical examination, and taking a vaginal swab.

Risks Associated with Bacterial Vaginosis

Bacterial vaginosis can significantly impact a woman’s quality of life and it places a notable burden on Australia’s health system. The condition has also been shown to increase risks of other serious issues, including:

• Acquiring other STIs (chlamydia, gonorrhea, and herpes simplex type 2)
• Acquiring HIV
• Transmitting HIV to male partners
• Miscarriage
• Premature labour
• Low infant birth weight
• Bacterial infection of the lining of the uterus after childbirth (endometritis)
• Pelvic inflammatory disease

Why Treat Male Partners?

Medical research recently published in the New England Journal of Medicine has confirmed that bacterial vaginosis is sexually transmissible, so it makes sense to treat the male partners of women affected by the condition as well.

The latest advice from the Royal Australian College of General Practitioners (RACGP) recommends that male partners of women who have been diagnosed with bacterial vaginosis and who are in a heterosexual, monogamous relationship should be treated concurrently.

How is Bacterial Vaginosis Treated?

Treatment of bacterial vaginosis is indicated both when women experience symptoms or are asymptomatic but known or suspected to be affected. It is also recommended in some women undergoing an invasive upper genital tract procedure such as IUD insertion or an abortion; this helps reduce the risk of developing pelvic inflammatory disease and/or endometritis.

The standard treatment for bacterial vaginosis in women is using a topical vaginal cream (metronidazole or clindamycin 2%).

According to the abovementioned medical study results, the cycle of reinfection by bacterial vaginosis can more effectively be broken by treating male partners of affected women with both oral and topical antibiotics.  This involves men taking a twice-daily oral dose of metronidazole 400mg tablets and using 2% clindamycin cream, which is applied to the penis (glans, upper shaft, and under the foreskin if it is present) twice daily. Male treatment is undertaken for seven days.

While biological men do not exhibit symptoms of bacterial vaginosis, the bacteria can be detected in the urethra of a male carrier, as well as under the foreskin (if uncircumcised) and in the groove under the head of the penis. These areas are not sufficiently accessed by topical antibiotic treatment, hence the need for men to take oral antibiotics as well.

During treatment, it is important to avoid sexual contact, or consistently use condoms (note that topical cream used intravaginally may weaken latex condoms).

It’s important to note that the current alteration to bacterial vaginosis treatment recommendations at this stage applies only to men in monogamous, heterosexual relationships and with an affected female partner. Heterosexual people in non-monogamous relationships should discuss their best options with their doctor.

Studies are being undertaken on how these results should be applied to people in the LGBTQI+ community.

BV Prevention Tips

1. Always use condoms consistently with new sexual partners and unless you are in a long-term, mutually monogamous sexual relationship. If you are sensitive to latex, choose latex-free condoms.
2. Do not douche or use vaginal rinses (these disrupt the natural bacteria balance in the vagina). Do not use vaginal deodorants.
3. Avoid using strongly-scented soaps, bubble baths, and bath oils.
4. Wipe from front to back when you use the toilet.
5. Change menstrual products (tampons, pads, liners) frequently – and consider using unscented products.
6. Wear breathable cotton underwear and change it at least once daily.
7. Maintain a healthy diet and limit sugars. Drink plenty of water.
8. Treat yeast infections and see your doctor if they persist.
9. Taking probiotic supplements may help prevent yeast infections and bacterial imbalances in the body.

See your doctor if:

1. You have vaginal discomfort, a change in normal vaginal discharge, or your vagina or discharge smells unusual.
2. You’ve self-treated a yeast infection but it has not resolved or it recurs.
3. You have had vaginal infections before and have new symptoms.
4. You have multiple sexual partners.

Choose Gynaecology Centres Australia for STI Healthcare

As well as surgical abortion services and IUD insertion under sedation, GCA offers comprehensive women’s sexual health services, including STI screening and treatment. We can help you and your partner overcome issues with bacterial vaginosis for a healthier life and enhanced well-being.

Contact us today to book a consultation in one of our clinics – located in Sydney, Wollongong, Newcastle, and Gosford.

Contact us online or call (02) 9585 9599.