Background 

Bacterial vaginosis (BV) is a polymicrobial infection associated with a loss of vaginal lactobacilli and an increase in anaerobic and facultative anaerobic bacteria (termed BV-associated bacteria). Previously, first line treatment options were provided only to the person with BV (7 days of oral metronidazole OR 7 nights of intravaginal clindamycin cream OR 5 nights of intravaginal metronidazole gel for the person with BV1), but over 50% experienced BV recurrence within 6 months. BV recurrence is associated with lack of condom use and exposure to an ongoing sex partner, and studies show that BV has the profile of a sexually transmitted infection (STI). BV-bacteria are commonly detected in the urethra and on the penile skin of ongoing sex partners who have a penis, particularly in the sub-preputial space of uncircumcised individuals. BV-bacteria are usually present without symptoms, meaning people with penises are commonly asymptomatic carriers2.

Reducing BV recurrence through partner treatment 

A recent randomised controlled trial found that BV cure is greatly improved when partners with a penis are treated with antibiotics administered concurrently with standard antibiotic treatment for the person with BV3. Partner treatment involved oral metronidazole 400mg twice daily AND 2% clindamycin cream applied twice daily to the glans, sub-preputial space and upper shaft of the penis, both for 7 days. Couples were advised to synchronise treatment and abstain from all sexual contact throughout the treatment period. The intervention, trialled in monogamous couples, resulted in a >60% reduction in risk of BV recurrence over 12 weeks. This is the first intervention in decades to demonstrate a very significant improvement in BV cure. 

As a result of this study and the additional evidence supporting the use of partner treatment for BV, the treatment guidelines at Melbourne Sexual Health Centre have been updated. The updated guidelines recommend the provision of combined oral and topical antibiotics for regular sex partners with a penis who have a partner with BV. Couples should try to synchronise treatment where possible. It is important to abstain from sex throughout the treatment period as recommended for typical STIs. 

Dispensing partner treatment 

Dispensing oral metronidazole  

400mg oral metronidazole, to be taken with food, twice daily for 7 days. 

Dispensing topical clindamycin 

2% Clindamycin phosphate cream is packaged as Dalacin V Cream and comes with 7 vaginal applicators and instructions for vaginal use. Please discard the applicators when dispensing and refer to the instructions below for penile application. Cream should be applied twice daily for 7 days.  

References 

  1. Australian STI management guidelines for use in primary care. (2024) Bacterial vaginosis. https://sti.guidelines.org.au/sexually-transmissible-infections/bacterial-vaginosis/ 
  2. Vodstrcil LA, Muzny CA, Plummer EL, Sobel JD, Bradshaw CS. Bacterial vaginosis: drivers of recurrence and challenges and opportunities in partner treatment. BMC Med. 2021;19:194. doi:10.1186/s12916-021-02077-3.  
  3. Vodstrcil LA, Plummer EL, Fairley CK, Hocking JS, Law MG, Petoumenos K, Bateson D, Murray GL, Donovan B, Chow EPF, Chen MY, Kaldor J, Bradshaw CS. Male-partner treatment to prevent recurrence of bacterial vaginosis. NEJM. 2025;392:10. doi: 10.1056/NEJMoa2405404