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- [00:01]
Dr. Chapa Zobichyn
So good, so good, so good.
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Dr. Chapa Zobichyn
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Dr. Chapa Zobichyn
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Dr. Chapa Zobichyn
Podcast family. Trust me, it is coming from a place of all humility, honestly, and not arrogance, but with some confidence that I say the following because again, this is, I hope, the reason that you listen to our program. We put a lot of effort into this program. So from honestly, from all humility, I just have to say the following.
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Podcast Producer/Editor
Man, I'm tired of being right.
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Dr. Chapa Zobichyn
All right, so let me explain. Back on March 7, 2025, March 7, 2025, that is seven months ago, we reviewed a brand new publication that had just come out at that time from the New England Journal of Medicine that had to do with the treatment of male partners for patients who have recurrent BV to try to prevent recurrence. All right, once again, we did that on March 7, 2025. That was seven months ago.
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Podcast Producer/Editor
Man, I'm tired of being right.
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Dr. Chapa Zobichyn
In that episode from March 7, 2025, we gave clinical implications of that, some recommendations on what we could do based on that very well done clinical trial. Even though that study had limitations. You gotta go back and listen to that. From March 7, 2025. The title of that episode was Treat Men for BV Protection. In the question that we asked based on that New England Journal of medicine publication. Now seven months from that episode, meaning on October 16, 2025, seven months later, ACOG has now released a clinical practice update which we're gonna focus on in this episode. It's gonna be very brief because it's gonna be just a mini recap of what that study was back in New England Journal of Medicine, how they did that and the very, very brief recommendation from ACOG. Now, based on that which we actually covered seven months ago on March 7, 2025.
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Podcast Producer/Editor
Man, I'm tired of being right.
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Dr. Chapa Zobichyn
Trust me, it's coming from a place of all humility and not arrogance, but appropriate confidence. Because we gave these recommendations seven months ago. One more time.
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Podcast Producer/Editor
Man, I'm tired of being right.
- [02:56]
Dr. Chapa Zobichyn
All right, so here's what we're talking about here. We're going to cover just briefly recap the New England Journal Medicine publication. It was very well done, very deep study and it kind of shook things up here. And the question that we posed at the end of that episode was what do we do with this? We're going to answer that again in this episode, which is pretty much the same recommendation from this new ACOG CPU clinical practice update. All right, this came out October 16, 2025. Now, as we've said many times before, and having sat again and I'm very thankful for my time with ACOG leadership having sat in these committee meetings. Words mean something. Words are loaded. Okay, now I'm going to tell you what this CPU says and what it does not say. And we're going to give a little bit of clarification here about something that we mentioned in our original March 7, 2025 episode is is can we do expedited partner treatment for men for patients who have recurrent bv? Okay, so we're going to get into that in this episode. I kind of touched on that a little bit and in the previous episode seven months ago. And the short answer is that depends on who you ask. ACOG has an answer, but it really is deeper than that is. It depends on what is in your state guidance. What's allowed by state. Texas does allow for expedited partner therapy, but but really it's for gonorrhea and chlamydia and trichomonas. BV is not mentioned in there. So I'm gonna tell you what ACOG says about expedited partner treatment for bv, which is different, of course, than expedited partner therapy for something that is non disputed like gonorrhea and chlamydia. Those should be stopped for public health, but it's a little bit more gray for bacterial vaginosis and whether or not expedited partner therapy EPT should be done in this case or not. Not that men shouldn't be treated. It's exactly what we're getting at. That yes, it's, it's something that can be considered. We'll get into those words here in a minute. Because the concurrent sexual partners treating the male partner of a patient with recurrent BV is something that should be considered. We're going to get into these words here in a minute, guys. We're going to give you the very brief. There's only two updated clinical recommendations and I'm going to give them to you right after the intro after we briefly just review what this trial was from the New England Journal of Medicine. So if you've Never heard of this. That potentially is our benefit of treating the men for patients with recurrent bv. You got to go back and listen to the background on March 7, 2025.
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Podcast Producer/Editor
Man, I'm tired of being right.
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Dr. Chapa Zobichyn
Because in that episode we talked about the CDC stance which currently says we don't have enough data. However, medicine moves fast. Right? That's our tagline. Medicine moves fast. And that is now technically outdated. We have plenty of information that bacterial vaginosis follows a pattern of sexual transmission and recurrent BV is definitely linked to sexual practice and sexual partners, especially multiple sexual partners. So yes, because of this brand new data that supports previous data that shows there is sexual activity transmission for bacterial vaginosis. Not that virgins can't get it, virgins can absolutely get bv. But it's much more likely in patients having sexual contact and intimacy, especially with multiple partners. And it's not for just heterosexual couples. It's not male and female pairs only. We know that there is predominance of BV and more likelihood of BV recurrence in women who have sex with women, same sex partners. And that's something that's also covered in this briefly. So we're going to cover just two. There's only two updated clinical recommendations that came out on October 16, 2025 from the college, even though we covered this seven months ago.
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Podcast Producer/Editor
Man, I'm tired of being right.
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Dr. Chapa Zobichyn
I think I've set it up enough. Let's get out of the intro before I get into any more trouble. And I'm going to recap here the study. We'll go into our CPU Rex and then we'll call it a day. We'll be right back. This is Dr. Chapa's OBGYN no Spin podcast Pass. Can I take your order? Can I get a tall chai?
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Coffee Shop Customer
A large black coffee?
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Nordstrom Rack Announcer
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Coffee Shop Customer
Large black coffee.
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Nordstrom Rack Announcer
Do you mean a venti?
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Podcast Producer/Editor
No, I mean a large.
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Coffee Shop Customer
He means a venti. Yeah, the biggest one you got.
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Nordstrom Rack Announcer
Venti is large.
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Coffee Shop Customer
No, Venti is 20. Yeah, large is large. In fact, tall is large. And grande is Spanish for large. Venti is the only one that doesn't mean large. He's also the only one that's Italian.
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Dr. Chapa Zobichyn
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Dr. Chapa Zobichyn
Uh, Limu is that guy with the binoculars watching us.
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- [09:48]
Dr. Chapa Zobichyn
Savings ferry underwritten by Liberty Mutual Insurance Company affiliates, excludes Massachusetts. All right, we get it. BV sucks. You get it once and then it's more likely to come back. Actually, 50 to 70% of women have recurrent episodes after the initial diagnosis. And just one of those things, it kind of sucks. And even though we've had some new treatments, we're all still in the basic treatment core, which is 500 milligrams of flagyl twice a day for seven days. Right? That's the old standard. It seems to work better than a stat dose. And we've covered recurrent BV treatment on a variety of different flavors. On past episodes, we've talked about painting the vagina purple. We've talked about that, about gent violet. We've talked about boric acid. We've talked about probiotics. We've covered all of those on this show in the past. But here's the previously controversial part. What about treating men? The CDC does have on their website a specific section about treatment of male sexual partners. And as of right now, it's like, you know, the data is kind of gray. I don't know, it's not really supported. So, yeah, let's just stick with what we know, which is kind of doing suppressive therapy for the patient. All right? Whether that's vaginal therapy, oral painting the vagina with gent violet or whatever, boric acid suppositories, whatever. Let's just kind of stick with that. That's kind of the CDC stance. All right? However, that kind of changed in March of 2025 when the new England Journal published a very well done study. It was multicenter, it was randomized, and it was well done. Even though there was a lot of limitations in there that you got to go back and listen to the episode that they. It wasn't Kind of a real clinical one. They kind of use Nugent's criteria. You got to go back and listen to that. Nonetheless, what they found was, was kind of eye opening. So let me just tell you briefly what this study was. So they took patients diagnosed with BV who had male sexual partners and they divided the treatment of the women into two groups. One was the usual group which was multi dose oral Flagyl twice daily for seven days or intravaginal Clinda, 2% Clinda cream for seven nights. Or a 75% 0.75% metronidazone gel which is Metrogel for five nights. Typical practice, right? That's typical standard. And they chose the vaginal treatments if, for, if whatever reason oral therapy was contraindicated. So that was the usual group in the study group. They gave the, that same therapy, either oral flagyl or vaginal metrogel or vaginal clinda. But the male partners were also given treatment. They were also given multi dose oral flagyl and topical 2% clinda gel that was applied externally of course, twice daily for seven days to the glans penis or under the foreskin if they were uncircumcised. All right, so it was two groups, okay, all these women have bv. All these women are having sex with dudes. And then one group got, hey, you just take your regular treatment, either oroflagil metrogel or vaginal clinda. And then the other group is, you do the same. But we're going to treat the dudes both with oral treatment and topical 2% clinda to the tip of the penis. Now the question is, well, why both? Well, because they know that men are terrible pill takers. So this was kind of to pick up the slack in case men said, yeah, we took it, but they really didn't. So it was nice, very smart. And knowing men as we are, it was kind of double coverage to make sure that they get good eradication here. And then they looked for recurrence. So all women, all women who were in the study group, in other words, whose male partners were treated had significantly less recurrence than those in the standard treatment. Okay, so they're like, oh, wow, this is a big deal. I mean, these results were pretty significant because the number of recurrence was absolutely significantly better in those that had male treatment. Now remember, there are some study limitations, but the short of it is the take home message is men were treated also. Okay, so here's the catch. Even though these were all heterosexual couples, that's a limitation because we don't know if this applies to same sex women having sex with women. Although you would figure the data would be the same if they're, you know, sharing a vaginal penetrative devices. Because what's been published is that in women who have sex with women and who use devices, oddly enough, they actually have the same microbiota vaginally, the same kind of procedures profile one with the other. Is that incredible or what? Which. Which makes sense. So even though we don't have direct data to say that this would work in same sex women, same sex couples for women, it. It's something that can be considered with shared decision making. And we can get into that as it relates to the actual recommendation here in a minute. All right, so that's just a quick recap of what the New England Journal of Medicine study was. We went more in detail, of course, back on March 7th, and I'm not gonna reh of it. Is standard treatment for women alone or standard treatment of women plus oral treatment for men as well as treatment of the glands with 2% clinda cream. Those who had combination treatment, men and women together, significantly had reduced recurrence of BV compared to those whose male partners were not treated. So that was a study that has now led seven months later to these two recommendations from the college and a quick blurb that they have regarding expedited partner treatment. Okay, so I thought, this is great. This is good stuff, because it's actually stuff that we basically went into seven months ago. Okay, so first let me give you the two recommendations. We could just knock that out. And then briefly, just briefly, we're going to talk about expedited partner treatment, because I think that's important here as well. All right, so first of all, the two recommendations, very similar to what we stated back in March, is, number one, quote, concurrent sexual partner therapy with a combination of oral and topical antimicrobial agents. Here it is, guys, don't lose. This should be considered for male sexual partners of adult patients with recurrent symptomatic bv. End quote. Okay, so there's a lot there. So let's just say that again. Concurrent sexual partners. I'm sorry. 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 bacterial vaginosis, end quote. That's the first recommendation. So this is in heterosexual couples who. Having symptomatic recurrent issues. We'll talk about first episodes in a minute and then notice the terms should be considered now notice should be considered as a softer loaded message than should be done or should be recommended. It's should be considered. All right, well, I considered it. That's a different level of, of, of burden of responsibility. Does everybody get this? Trust me, guys. And it's all about semantics. Sat on these committees for the last three to four years, guys, I don't. I think I said this on a previous episode for one, for about an hour on one of the past meetings on something unrelated to this, we talked about should it be should the term say could or should. Oh, my goodness. I mean, this is how deep these words actually mean. So when it says should be considered. All right, I'll consider it. That's all it means. It doesn't mean that you have to, nor does it mean that it is recommended. It just means as it reads, should be considered. Okay, so this is a very loaded issue. So back when I originally released the episode on March 7, I had a lot of messages that come into the show saying, so are we going to do this now? Is this recommended? Well, wait a minute. Recommended is something we, we are far from. Because even in the CPU it says, look, we don't have all the data. This study had some limitations. So, yeah, I guess. I mean, we should consider it. That's all it means, should be considered. Now, if it would have said, Let me read it again with different verbiage. And as you can see the contrast here, it does not say, let me be clear, it does not say, quote, concurrent sexual partner therapy with a combination of oral and topical antimicrobial agents should be done with or is recommended for male sexual partners of adult patients with recurrent symptomatic bacterial vaginosis, end quote. Do you see that? Those are totally different. All this says is, hey, should be considered. That's all. So I'm doing this for two reasons. One, I gotta let you know what's hot off the press. And this just came out October 16th. Second, if your patient asks you, you don't go, I don't know. I don't know what. I don't know what the college says about it. Well, remember, this is just clinical practice updates, a guidance. And so it says we should consider it. So let's consider it. So talk to the patient, especially for those with recurrent BV for male partner treatment, and we'll talk about expedited partner treatment in just a minute. The second clinical recommendation. We're going to start wrapping this up. The second clinical recommendation is this, quote, shared decision making. And let's stop there for A minute already, we've already weakened, kind of loosened the recommendation here. Does that make sense? So right now we've gone from all right, should be considered to something that's very different, which is now shared decision making. So this is now we're in gray zone. Quote, 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 bacterial vaginosis, end quote. Very fair. In other words, going, look, we have no data on this. Remember, that's where it says shared decision making. We're like, I'm going to take extrapolate other points of data kind of given to risk and benefits and then put that out there to you. And then I'm going to document that we had shared decision making. Same sex partners, maybe. We definitely know that. Again, sharing devices for same sex partners for women can alter the microbiota, which can facilitate bv. So, sure, share decision making. And for a patient who has a primary episode, share decision making. Because it doesn't mean they're gonna have a recurrence. It just means that 50 to 70% will. But at the same time, depends on how you read that, 30 to 50% won't. So I believe that for treatment of the first episode, giving male partner treatments like, man, now you're freaking me out. Why do I need to be treated? This is the first time this has happened. I think that's kind of overkill, but that's why it is shared decision making. All right, so those are the two recs, and I think we've dissected those enough. The first one is male partners. It should be considered for treatment in patients with recurrent symptomatic bv. And the second is shared decision making for same sex couples and or for the first symptomatic occurrence.
- [21:38]
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- [22:05]
Dr. Chapa Zobichyn
Now, this is going to be very quick, so I'm just telling you what you need to know and we're going to be done. Remember, this is just a cpu. It's not like a bunch of data. It's just this is very quick recommendations here. A quick word on expedited partner treatment. Number one, do what your state allows, okay? Which most allow for expedited partner treatment as a public health measure for gonorrhea, chlamydia and trich. No problem there. BV a little bit more gray because it's not a traditional sti, Although BV does have, of course, sexual modes of transmission and facilitation, but the public burden is a lot less. All right, this is why I'm going to read you the recommendation from the college. And my answer is, as a quick rebuttal is, hey, whatever your state does, you can do that. You can make a policy. Maybe it's make your group a policy to make sure it's okay. Check with your malpractice carrier, make sure it's all right. If this can fall under expedited partner treatment since it is kind of treating something that has a predominant sexual mode of transmission but is not a typical STI quote. Although the American College of Obstetricians and Gynecologists supports the practice of expedited partner therapy. Here it is, guys, here it is. And we're going to call it a day. 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. All to say, have them go get a televisit. Have them go get an in person visit rather than relying on expedited partner therapy. Although in all disclosure, guys, let me say it right here. I've done this. I've done this because I document. Well, I asked the patient, hey, if I give this partner treatment because this is driving you nuts and he's not going to go to televisit because he's a dude and he's not going to go get a visit in person because he's a dude. And I'm looking now for you. So I'm going to document that this is not clear. I've not established physician patient relationship with him. But to protect you, I'm going to give it. Are you okay with that? And they say yes. So I have done that, even though it's a little kind of gray because it's not a traditional sti. But I want to be very clear, I have done that for my patient protection, mainly when she has asked me for it. Okay? However, I don't really feel comfortable with that all that much. But I also want to be a patient advocate. So you see how difficult this is. But I document very, very well. And I tell the patient, look, if there's any kind of issue, you gotta let me know, you know, Having a true allergy to Flagyl is possible. Thankfully, it's pretty rare. And the whole disaffirma like reaction with alcohol may be overstated. We covered that in a previous episode months to years ago, where, yes, that's a thing. But you got to take a lot of Flagyl so that it can really make you sick for that disulfiram like reaction with alcohol. So all to say, I think it's okay. Definitely for topical. I have no problem with topical. It's the oral systemic therapy that potentially could be reaction generating in a patient you haven't seen, which can get kind of hairy. Okay? So to avoid all those issues, that's why ACOG says, look, not a traditional sti, even though we're all for EPT from a public health standpoint for the bad ones, let's just kind of not recommend it for this one at this time. Okay? So that's. I wanted to cover both sides there. Know what your state allows. Know what your policy and procedures is. Because ex bottom partner therapy is very gray with this one. Even though the condition has sexual modes of transmission and facilitation. Not a traditional STI in and of itself. Because to be an STI means you can only get it through sexual relations. And that's not the case we have. There's virginal patients, for example, who have an IUD in, and we know that that alters the microbiota and makes them prone to BV. So that's why it's not a traditional STI. We covered all of this, guys, back on March 7, 2025.
- [26:18]
Podcast Producer/Editor
Man, I'm tired of being right.
- [26:20]
Dr. Chapa Zobichyn
All right, now that we've done all that, I think we've done what we're supposed to do. That's kind of annoying, but it's kind of funny at the same time. Trust me, guys, honestly, coming from a place of true humility, not arrogance, man.
- [26:34]
Podcast Producer/Editor
I'm tired of being right.
- [26:36]
Dr. Chapa Zobichyn
We have covered ACOG's new Clinical Practice Update released on October 16, 2025. The title of this is Concurrent Sexual Partner Therapy to Prevent Bacterial Vaginosis Recurrence. Podcast family, as always, we're super thankful for you. Thank you for your support. Thank you for being part of our podcast family. And now that we've done all that, let's take it home. This has been Dr. Chapa Zobichyn, no Spin Podcast Podcast family. Thank you for your support. Thank you for listening. And as always, we'll see you on another episode of the no Spin Podcast.