Authors: Jacqueline Ugwuneri, Sira Jaffri, Meghan Etsey, Teresa Lazar, MD on behalf of the AMWA Gender Equity Task Force

Bacterial vaginosis (BV) has traditionally been conceptualized and treated as a condition exclusive to women, reflecting long-standing gender asymmetries in sexual and reproductive health research. This framing has not only reinforced the disproportionate expectation that women bear sole responsibility for diagnosis, management, and recurrence prevention, but has also limited our understanding of BV as a relational and microbiological phenomenon influenced by sexual partnerships. Emerging evidence indicating potential male involvement in BV recurrence challenges these historical assumptions and underscores the need for a more equitable, evidence-based approach to sexual health. Addressing BV through a gender equity lens invites a reframing of responsibility, one that emphasizes shared health accountability, inclusive research design, and the dismantling of gendered biases in clinical practice. 

Management of sexual partners in BV has historically not included partner treatment, as multiple randomized controlled trials and systematic reviews found no benefit in reducing recurrence or improving cure rates when male partners were treated with oral antibiotics alone. The United States Centers for Disease Control and Prevention (CDC) guidelines explicitly state that routine treatment of sex partners is not recommended, based on these data, and recommend standard therapy for symptomatic women only. The CDC also notes that while BV-associated bacteria can be identified on male genitalia, prior trials using oral antimicrobials for male partners did not reduce recurrence in women. (Workowski et. al., 2021). However, recent research has challenged this paradigm. A 2025 multicenter randomized controlled trial published in The New England Journal of Medicine demonstrated that concurrent treatment of male partners with both oral metronidazole (400 mg twice daily for 7 days) and topical 2% clindamycin cream applied to the penile skin twice daily for 7 days, in addition to standard therapy for women, significantly reduced BV recurrence at 12 weeks compared to treating women alone. This approach targets both the penile urethra and cutaneous sites, addressing limitations of prior studies that used oral therapy alone. Adherence to the combined regimen was high, and adverse events were mild and infrequent (Vodstrci et. al., 2025) 

This combined approach disrupts the cycle of bacterial transmission and recolonization between partners, highlighting the significant contribution of the male anatomy to the perpetuation of BV and the importance of gender equity in its treatment. The newly observed success with the inclusion of topical antibiotics is also likely to be particularly important in uncircumcised males who have a high abundance of sub-preputial BV-associated bacteria. Male circumcision has been shown to reduce the detection of BV-associated genera in males and reduce the BV acquisition in women, providing further evidence that cutaneous carriage of BV-associated bacteria plays an important role in the pathogenesis of BV acquisition and recurrence. (Plummer et. al., 2018)

These findings reinforce that BV is not exclusive to women, but rather a shared condition that requires adequate clinical treatment for both partners. By adopting a more gender-equitable and inclusive lens, clinicians can better understand and help break the cycle of BV recurrence, as well as improve health outcomes for all patients. Addressing BV on a larger scale requires inclusive initiatives and health strategies to include both genders in screening, education, and treatment. Ensuring that clinical practice reflects the reality of shared health responsibility is integral to making strides towards a more holistic model of sexual and reproductive health. 

Incorporating gender equity into the clinical and research landscape of bacterial vaginosis is not merely a matter of fairness, but of scientific rigor and public health efficacy. As ongoing studies continue to investigate the potential benefits of treating male partners, the field stands at an important inflection point: whether to perpetuate traditional, gendered models of disease responsibility or to embrace a more integrated, partnership-based framework for care. Recognizing BV as a shared health concern necessitates a paradigm shift, one that values relational dynamics, mutual accountability, and inclusive health communication. Only through such an approach can we ensure that interventions are both biologically informed and socially just, ultimately improving outcomes for all individuals affected by this common yet complex condition. 

References: 

Plummer, E. L., Vodstrcil, L. A., Danielewski, J. A., et al. (2018). Combined oral and topical antimicrobial therapy for male partners of women with bacterial vaginosis: Acceptability, tolerability and impact on the genital microbiota of couples – A pilot study. PloS one, 13(1), e0190199. https://doi.org/10.1371/journal.pone.0190199 

Vodstrcil, L. A., Plummer, E. L., Fairley, C. K., et al. (2025). Male-partner treatment to prevent recurrence of bacterial vaginosis. The New England Journal of Medicine, 392(10), 947–957. https://doi.org/10.1056/NEJMoa2405404

Workowski, K. A., Bachmann, L. H., Chan, P. A., et al. (2021). Sexually transmitted infections treatment guidelines, 2021.MMWR Recommendations and Reports, 70(4), 1–187. https://doi.org/10.15585/mmwr.rr7004a1

About the Authors

Jacqueline Ugwuneri, MS3

Jacqueline Ugwuneri is a third-year medical student at St. George’s University School of Medicine. She earned her Bachelor of Arts in Cognitive Science with a concentration in Cognitive Neuroscience from Rutgers University in New Brunswick, NJ. She served as President of the St. George’s University chapter of the Student National Medical Association (SNMA), where she organized mentorship programs, health fairs, and professional development events that fostered community engagement and empowered minority medical students to thrive both academically and personally. Before medical school, she worked as a medical assistant and care coordinator across several specialties, including Family Medicine, Minimally Invasive Gynecologic Surgery (MIGS OB/GYN), Infectious Disease, and Breast Surgical Oncology. When she isn’t caring for patients on the wards or studying, she enjoys vlogging her medical journey, working out, spending time with friends and family, and mentoring aspiring minorities in medicine. She hopes to continue inspiring others by bridging her passion for storytelling, leadership, and advocacy in the pursuit of a more equitable future in healthcare.

Sira Jaffri

Sira Jaffri is a medical student at St. George’s University. Her previous research centers on STEM student mental health and wellness, with a focus on student stressors, LGBTQ+ experience in STEM, and utilization of student support programs. She is passionate about exploring how diverse student backgrounds and institutions impact well-being and academic success, contributing to the broader conversation on promoting student wellness and preventing burnout in higher education.

Meghan Etsey, MS4

Meghan Etsey is a fourth year medical student from St. George’s University. She has a Bachelors of Arts in Biology and a Bachelors of Arts in Nutrition and Dietetics from Bluffton University in Bluffton, Ohio. She served as the President of the St. George’s University’s Women in Medicine chapter in St. George, Grenada where she expanded relationships with the community and worked towards educating women and helping the youth. She is also a member of the Gender Equity Task Force and Sex and Gender Health Collaborative Committees within the American Medical Women’s Association. When she is not pursuing medicine, you can find her with her friends and family on different road trips and adventures exploring the world. 

Teresa Lazar, MD MSEd is the clerkship director of the Advanced Clinical Experience in Obstetrics and Gynecology and Assistant Professor at the Donald and Barbara Zucker School of Medicine at Hofstra Northwell (ZSOM). She obtained her medical degree and completed her residency in obstetrics and gynecology from the State University of New York Health Science Center in Brooklyn and graduated with a Master of Science in Education degree in health professions from Hofstra University. Dr. Lazar was recognized with the APGO Excellence in Teaching Award and is a member of the Academy of Medical Educators and Alpha Omega Alpha Honor Medical Society at the ZSOM. Currently, a member of the American Medical Women’s Association Gender Equity Task Force and the Education Committee. Dr. Lazar is board certified by the American Board of Obstetrics and Gynecology, areas of clinical interest include general obstetrical care, gynecologic care and pelvic ultrasounds. Additionally, she is passionate about medical education, faculty development, communication, and leadership. She is fluent in both English and Spanish.  

Formatting, publication management, and editorial support for the AMWA GETF Blog by Vaishnavi J. Patel, DO