Patients who suffer from bacterial vaginosis consistently may, in the hope of recovering, try a variety of treatments. They might alter their clothing, diet, and feminine hygiene products. They try over-the-counter supplements. Most of the time, these methods are used in conjunction with the antibiotics that are given to them orally or topically by their doctors. These antibiotics usually work for a while before the infection comes back. Recurrences are frustrating, and over time, the condition can have a significant effect on their quality of life and relationships.
Bacterial vaginosis (BV) is a common gynecologic condition — the one that most often sends women to their doctors. It is a complicated dysbiosis of the vagina, and while it has long been known to be associated with sexual activity, it can also occur without sex. In March 2025, however, the New England Journal of Medicine published an Australia-based study showing that treating BV like a sexually transmitted infection (STI), and treating patients’ male partners with oral and topical medications, led to a lower rate of recurrence of BV.
Controversial headlines calling BV an STI and a suggestion that it was time to modify treatment guidelines to include medicating patients' partners were among the findings of the study. At Cleveland Clinic’s Obstetrics and Gynecology Institute, Oluwatosin Goje, MD, Medical Director of the Center for Infant and Maternal Health, is focused less on the STI labeling and more on counseling patients to lean into practices proven to be helpful in reducing recurrences.
Dr. A comparison of the microbiome of patients with acute recurrent BV to healthy controls is part of Goje's own research on BV. She examined the effects of metronidazole on “good” and “bad” flora in participants with BV. In the first week, improvements in the balance were noted, but they were not sustained. The treatment options for BV are still limited. Metronidazole and clindamycin have remained the CDC's treatment recommendations for many years. That makes the question of how those medications are used of significant interest to researchers hoping to find a breakthrough.
“The Australian study strengthens the hypothesis that BV is sexually associated, and that encouraging patients to change their diet or change their undergarments can be unnecessarily stressful,” says Dr. Goje. “They come back and say that they've changed these things, but nothing has changed. Those changes might be good for hygiene and for staying healthy, but we don't think they make a difference with BV.”
The Australian study's premise was that heterosexual partners' shared microbiome. The participants were single, heterosexual women who had been together for at least eight weeks and were willing to use treatment. The women were all tested for BV and treated with oral antibiotics. They did not test their partners for BV. Men in the intervention group received oral metronidazole and 2% clindamycin topical cream to apply to the penis.
The control group's men got nothing. There was a 35 percent infection-return rate among the 81 couples in the intervention group. Infection returned for 63% the control group (81 couples). Because participants performed significantly worse when men were not treated, the study was terminated early. Headaches, nausea, and a metallic taste are among the side effects experienced by 46% of treated men. The study, according to Dr. Goje, suggests that treating male partners may be useful for some patients with BV. However, she goes on to say that "if BV is sexually associated, patients who are sensitive to changes in their bacterial flora might benefit from their partners using condoms." This is easier than getting medication to everyone, especially for patients who change partners frequently or have multiple partners. This is in addition to medication suggested by a provider.”
Recurrent versus refractory BV
Dr. Goje notes that there is a difference between recurrent and refractory BV. According to the results of testing, some patients experience treatment-induced relief from BV but then recur. When a person experiences three episodes within a 12-month period, BV is considered recurrent. For patients with refractory BV, treatment fails to relieve symptoms.
“For them, we have been adding boric acid vaginally, which can disrupt a biofilm that can cover the vagina and prevent adequate penetration of the medication,” she says. “So in patients with refractory BV, it's possible that it's due to that biofilm, and two medications — the boric acid vaginally and an oral medicine — can be more beneficial than just using the boric acid alone or the oral medicine.
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