Bacterial vaginosis: Treating men and women partners may lower recurrence rate

About one-third of women of reproductive-aged are affected by bacterial vaginosis.1 Bacterial vaginosis is associated with multiple adverse outcomes, including an increased risk of adverse birth outcomes, acquisition of human immunodeficiency virus and other sexually transmitted infections, pelvic inflammatory disease and a high incidence of symptomatic recurrence.2 International guidelines recommend metronidazole or clindamycin as first-line treatment for affected women. However, this treatment strategy does not result in a sustained cure, with more than 50% of women having a recurrence within three months,1 or up to 60% at 12 months.2Some evidence suggests that bacterial vaginosis–associated organisms are exchanged sexually between partners and that men may harbor bacterial species associated with bacterial vaginosis in the distal urethra and under the foreskin of the penis (subpreputial space). As a result, it has been hypothesized that treatment of women and their male partners may reduce the rate of recurrence.1 To examine this issue, an open-label, randomized, controlled trial was conducted in Australia. The study included couples in which a woman had bacterial vaginosis and was in a monogamous relationship with a male partner. In the partner-treatment group, the woman received first-line recommended antimicrobial therapy and the male partner received oral and topical antimicrobial treatment (metronidazole 400 mg tablets and 2% clindamycin cream applied to penile skin, both twice daily for seven days). In the control group, the woman received first-line treatment and the male partner received no treatment (standard care). The primary outcome was recurrence of bacterial vaginosis within 12 weeks.1Results showed the following:The partner-treatment group included 81 couples; the control group included 83 couples.Most women (87%) had a history of bacterial vaginosis and an uncircumcised male partner (80%); nearly a third of the women used an intrauterine device (IUD), which is a known risk factor for bacterial vaginosis..The trial was stopped early by the data and safety monitoring board after 150 couples had completed the 12-week follow-up period because treatment of the woman only was inferior to treatment of both the woman and her male partner.In the modified intention-to-treat population, recurrence occurred in 24 of 69 women (35%) in the partner-treatment group (recurrence rate, 1.6 per person-year; 95% confidence interval [CI], 1.1–2.4) and in 43 of 68 women (63%) in the control group (recurrence rate, 4.2 per person-year; 95% CI, 3.2–5.7). This corresponded to an absolute risk difference of −2.6 recurrences per person-year (95% CI, −4.0 to −1.2; p

Bacterial vaginosis: Treating men and women partners may lower recurrence rate

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