Podcast Summary

Dr. Chapa’s OBGYN Clinical Pearls

Episode: New CPU: Male RX for BV (10/16/25)
Date: October 17, 2025
Host: Dr. Chapa Zobichyn
Focus: Review and implications of the new ACOG Clinical Practice Update (CPU) recommending consideration of male partner therapy to reduce recurrence of Bacterial Vaginosis (BV).

Episode Overview

This episode centers on the October 16, 2025, ACOG Clinical Practice Update regarding male partner therapy for preventing recurrent BV in women—a discussion Dr. Chapa originally addressed in March 2025, highlighting how clinical practice is rapidly evolving. Dr. Chapa recaps the pivotal New England Journal of Medicine (NEJM) study that triggered these recommendations and unpacks the nuances of ACOG's guidance and its implications in everyday clinical practice, with a focus on shared decision-making and the legal/ethical considerations around expedited partner therapy (EPT).

Key Discussion Points and Insights

1. Setting the Stage: BV Recurrence and Partner Therapy

• Recurrent BV is common: “50 to 70% of women have recurrent episodes after the initial diagnosis.” [09:47]
• Standard treatments (oral/vaginal Flagyl or Clinda, boric acid, probiotics) are often inadequate at preventing recurrence.
• The role of sexual transmission in BV recurrence is significant, prompting interest in treating sexual partners—particularly male partners.

2. The Landmark Study (NEJM, March 2025 Recap)

• Design: Multi-center, randomized trial of women with BV and male sexual partners.
  • Control group: Standard therapy for women (oral Flagyl/metronidazole, vaginal Clinda, or Metrogel).
  • Intervention group: Same therapy for women plus male partners received multi-dose oral Flagyl and topical 2% clindamycin gel applied to the glans penis (and under foreskin).
• Rationale: “Men are terrible pill takers… So it was nice, very smart…double coverage.” [11:23]
• Findings: “All women who were in the study group…whose male partners were treated had significantly less recurrence than those in the standard treatment.” [12:43]

3. New ACOG CPU Recommendations (October 2025)

Dr. Chapa reads and discusses the ACOG recommendations, emphasizing the importance of precise language:

Recommendation 1: Consideration for Heterosexual Male Partners

• Official Language:
  “Concurrent sexual partner therapy with a combination of oral and topical antimicrobial agents should be considered for male sexual partners of adult patients with recurrent symptomatic BV.” [15:19]
• Dr. Chapa’s Take:
  “Notice ‘should be considered’ is a softer, loaded message than ‘should be done’ or ‘should be recommended.’...That’s all it means—should be considered.” [16:39]

Recommendation 2: Shared Decision-Making for Same Sex Partners/First Occurrence

• Official Language:
  “Shared decision making regarding concurrent sexual partner therapy is recommended for adult patients with recurrent symptomatic bacterial vaginosis who have same sex partners and for patients with a first occurrence of symptomatic BV.” [18:45]
• Dr. Chapa:
  “‘Shared decision making’...now we’re in the gray zone. Going look, we have no data on this.” [18:51]
  “For treatment of the first episode, giving male partner treatment...I think that’s kind of overkill, but that’s why it is shared decision making.” [19:26]

4. Expedited Partner Therapy (EPT): Legal and Practical Considerations

• What is EPT? Prescribing treatment for a patient’s partner without direct evaluation.
• ACOG stance:
  “This is not a recommended strategy for the management of bacterial vaginosis because the provision of expedited partner therapy is regulated by state and local laws that generally permit its implementation only in cases of gonococcal infection, chlamydial infection, and sometimes trichomoniasis.” [24:10]
• Dr. Chapa’s practice:
  “I’ve done this because I document. Well, I ask the patient...Are you okay with that? And they say yes. So I have done that, even though it’s a little kind of gray.” [24:47]
• Key point: Check local/state regulations and malpractice coverage when considering EPT for BV.

5. Memorable Quotes and Moments

• On being ahead of the curve:
  “Podcast family...from all humility, I just have to say the following...”
  Producer/Editor repeatedly jokes:
  “Man, I’m tired of being right.” [01:01, 01:32, 02:41, etc.]
• On semantics in guidelines:
  “Words mean something. Words are loaded...We spent about an hour on one of the past meetings…Should it be ‘could’ or ‘should’? Oh my goodness.” [15:41]
• On the practicalities of male compliance:
  “Men are terrible pill takers...double coverage to make sure that they get good eradication here.” [11:23]
• On practice realities:
  “I want to be a patient advocate. So you see how difficult this is. But I document very, very well.” [25:10]

Notable Timestamps

• [01:03] Introduction of prior episode and its predictions on male RX for BV
• [09:47] The issue of high BV recurrence and standard vs. alternative treatments
• [10:53] Recap of NEJM study design and findings
• [12:43] Outcomes: Significant reduction in recurrence with male partner treatment
• [15:19] Reading ACOG recommendation #1 ("should be considered")
• [18:45] Reading ACOG recommendation #2 ("shared decision making")
• [22:04] Deep dive into EPT, legal/ethical landscape, and Dr. Chapa’s approach
• [24:10] Direct quote of ACOG’s statement on EPT for BV
• [26:35] Summation and episode close

Summary Table: New ACOG Recommendations

| Patient Situation | ACOG Guidance | Clinical Action | |----------------------------------------|-------------------------------------|-------------------------------------------| | Recurrent BV, male sexual partner | Should be considered | Discuss with patient, consider treatment | | Same-sex partners or BV first episode | Shared decision making recommended | Engage in collaborative decision | | EPT for BV | Not recommended | Follow state/local law, document carefully|

Key Takeaway

New ACOG guidance acknowledges and supports considering male partner therapy—both oral and topical antibiotics—to reduce BV recurrence in women with recurrent symptomatic BV, but stops short of recommending it outright. For same-sex partners or first-time BV episodes, shared decision-making is advised. The practice of EPT for BV remains legally and ethically nuanced; always check local policies and document thoroughly.

Dr. Chapa’s bottom line:
Stay abreast of evolving data and guidance, involve the patient in decision-making, and always mind the “loaded” language of clinical recommendations.

“We have covered ACOG’s new Clinical Practice Update released on October 16, 2025…Concurrent Sexual Partner Therapy to Prevent Bacterial Vaginosis Recurrence.” [26:35]