For some cases of bacterial vaginosis, treatment should include a package deal, doctors now say.
The American College of Obstetricians & Gynecologists (ACOG) updated its clinical guidance Friday to fit with recent data indicating that treatment for recurring bacterial vaginosis (BV) in women is significantly more effective if their male partners are also treated at the same time—with both an oral antibiotic and an antibiotic cream directly onto the potentially offending member.
“Partner therapy offers us another avenue for hopefully preventing recurrence and helping people feel better faster,” Christopher Zahn, chief of clinical practice and health equity and quality at ACOG, said in a statement.
BV is a common condition affecting nearly 30 percent of women worldwide. Still, it’s potentially stigmatizing and embarrassing, with symptoms including itching, burning, a concerning fishy smell, and vaginal discharge that can be green or gray. With symptoms like this, BV is often described as an infection—but it’s actually not. BV is an imbalance in the normal bacterial communities that inhabit the vagina—a situation called dysbiosis.
This imbalance can be especially difficult to correct; of the women who suffer with BV, up to 66 percent will end up having the condition recur after treatment.
BV symptoms are “incredibly uncomfortable and disrupt people’s daily lives,” Zahn said, and that discomfort “becomes compounded by frustration when this condition comes back repeatedly.”
Firm recommendation
Studies in recent years have started to expose the reasons behind recurrence. Though again, BV is an imbalance, it has the profile of a sexually transmitted infection, with links to new sexual partners and similar incubation periods. Going further, microbial communities of penises can silently harbor the bacterial species linked to BV, and penile microbial communities can be predictive of BV risk in partners.
Earlier this year, a randomized, controlled trial published in the New England Journal of Medicine found that when heterosexual, monogamous couples were treated for BV together, the rate of recurrence in female partners was just 35 percent. That’s compared with 63 percent in the control group, in which just the females received treatment.
The study had limitations. It was small, mostly recruited from one clinical center, and some of the men in the treatment group did not complete their antibiotic treatment. However, the data was enough to convince doctors to update their treatment plans.
The full update to ACOG’s guidance recommends that couples consider “concurrent sexual partner therapy with a combination of oral and topical antimicrobial agents for male sexual partners of adult patients with recurrent, symptomatic BV.” ACOG also suggests doctors and patients discuss concurrent treatment for recurrent, symptomatic BV in patients with same-sex partners, and concurrent treatment for patients who have their first case—not a recurrence—of BV.
“We recognize that it may be difficult to initiate a conversation with a sexual partner about BV,” Anna Powell, an author of the clinical guidance, said, “but what I want patients to know is that having a conversation about it and getting your partner connected with treatment could ultimately help decrease the risk that they continue to have symptoms.”
ACOG said it looks forward to more research to make firmer recommendations for nonheterosexual and nonmonogamous couple treatment, and for treatment of asymptomatic BV.
