ACOG Recommends Concurrent Sexual Partner Treatment for Recurrent Bacterial Vaginosis for the First Time

Washington, D.C. - New guidance from the American College of Obstetricians & Gynecologists (ACOG) aims to change the way people experiencing recurrent bacterial vaginosis (BV) are treated. Today, ACOG issued a Clinical Practice Update recommending concurrent sexual partner therapy for some patients experiencing recurrent bacterial vaginosis. These recommendations follow new data and increasing evidence supporting the efficacy of sexual partner therapy in reducing recurrences of BV.

The updated recommendations include considering concurrent sexual partner therapy with a combination of oral and topical antimicrobial agents for male sexual partners of adult patients with recurrent, symptomatic BV. They also include using shared decision making regarding concurrent partner therapy for adult patients with recurrent, symptomatic BV who have same-sex partners and for patients with a first occurrence of symptomatic bacterial vaginosis.

Recurrent bacterial vaginosis is extremely common: Up to 66% percent of women experience a recurrence within a year of treatment for their original presentation.

"Symptoms of bacterial vaginosis can be incredibly uncomfortable and disrupt people's daily lives. The discomfort of bacterial vaginosis, or BV as some patients may know it, becomes compounded by frustration when this condition comes back repeatedly and is difficult to treat. Partner therapy offers us another avenue for hopefully preventing recurrence and helping people feel better faster," said Christopher Zahn, MD, FACOG, chief of clinical practice and health equity and quality at ACOG.

Bacterial vaginosis occurs when there is an imbalance in the types of normal bacteria that live in the vagina; it is not an infection. Symptoms of this condition can include itching and increased vaginal discharge that has a strong, fishy odor.

"Due to its unique symptoms, bacterial vaginosis can feel stigmatizing, and many patients may be embarrassed about their condition, especially when it recurs. New data, along with several prior publications, show that sexual activity plays an important role in BV incidence and recurrence. We recognize that it may be difficult to initiate a conversation with a sexual partner about BV, 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," said Anna M. Powell, MD, MSCR, FACOG, named author of the clinical guidance.

ACOG's recommendations follow new research findings on male sexual partner therapy and a growing body of evidence implicating sexual activity as a risk factor. Previously, data did not demonstrate a clear benefit for the use of concurrent sexual partner treatment in managing recurrence. More research is still needed for certain populations, particularly people with same-sex sexual partners, people in nonmonogamous relationships, and people with asymptomatic bacterial vaginosis.

"Our knowledge of how bacteria spread and grow is constantly evolving. ACOG's new recommendations to in some circumstances treat the sexual partners of people with recurrent bacterial vaginosis follow the data available to us at this time. I am hopeful that there will soon be more research into how to best treat the partners of our patients who are not in heterosexual, monogamous relationships. All people deserve access to evidence-based health care, and we need more inclusive research to bring that evidence-based care to our patients," said Jenell S. Coleman, MD, MPH, FACOG, named author of the guidance and member of ACOG's Immunization, Infectious Disease, and Public Health Preparedness Expert Work Group.

ACOG's Clinical Practice Update is available now. This document updates related content in Practice Bulletin 215: "Vaginitis in Nonpregnant Patients."