Dr. Chapa’s Clinical Pearls: Treat MEN for BV Protection in Women?

Episode Release Date: March 7, 2025
Podcast Description: Relevant, evidence-based, and practical information for medical students, residents, and practicing healthcare providers regarding all things women’s healthcare. Clinically relevant, engaging, and fun!

1. Introduction and Context

Dr. Chapa opens the episode by highlighting the continuous evolution of understanding and treating bacterial vaginosis (BV), particularly focusing on the novel approach of treating male partners to reduce recurrence in women.

[00:00] Dr. Chapa: "We try to get you stuff that's fresh off print...something came out yesterday, March 5th, 2025, in the New England Journal of Medicine."

He references prior discussions on BV, recurrent vaginosis, and various treatments, setting the stage for the new findings he will explore.

2. Overview of the 2021 Pilot Study

Dr. Chapa revisits the 2021 pilot study conducted by an Australian research team, which explored the efficacy of treating male partners to prevent BV recurrence in women.

[02:10] Dr. Chapa: "The title is a prospective open label pilot study of concurrent male Partner treatment for BV."

This study initially showed promising results, leading to the hypothesis that male partner treatment could reduce the risk of recurrent BV in female patients. However, the CDC's stance based on this study remained cautious.

3. CDC Guidelines and Current Stance

Dr. Chapa discusses the CDC's position on male partner treatment for BV, which remained conservative despite the pilot study's findings.

[10:53] Dr. Chapa: "The CDC says routine treatment of sex partners is not recommended."

He emphasizes that while the pilot study suggested potential benefits, larger-scale evidence was needed before changing clinical guidelines.

4. The New 2025 NEJM Study

The centerpiece of the episode is the newly published March 5, 2025, study in the New England Journal of Medicine by the same Australian team. This study expanded on their previous work with a larger sample size to validate earlier findings.

[15:45] Dr. Chapa: "The addition of oral and topical antimicrobial therapy for male partners... resulted in significantly lower recurrence rates over 12 weeks."

Study Highlights:

• Design: Open-label, randomized controlled trial with over 160 couples.
• Intervention: Male partners received a combination of oral metronidazole (400 mg twice daily) and topical 2% clindamycin cream applied to the penile skin twice daily for seven days.
• Control: Standard female-only treatment.
• Primary Outcome: Recurrence of BV within 12 weeks, defined by both Amsel’s criteria and a Nugent score of 4-10.
• Results:
  • Intervention Group: 35% recurrence rate.
  • Control Group: 63% recurrence rate.

[22:00] Dr. Chapa: "Those who were in the intervention group... had a recurrence of BV of 35%, compared to 63% in the control group."

He notes that the intervention effectively halved the recurrence rate, though it did not eliminate it entirely.

5. Discussion on Condom Use and Previous Studies

Dr. Chapa delves into the role of condom use in preventing BV recurrence, referencing a 2008 systematic review that supported condom usage as a beneficial preventive measure.

[19:30] Dr. Chapa: "Condoms do have some kind of benefit in prevention of recurrent BV... a systematic review back in 2008."

He contrasts the new study with a 2013 trial where a different male treatment approach—using a 62% ethyl alcohol gel—actually increased BV rates, highlighting the importance of treatment modality.

[20:15] Dr. Chapa: "The 2013 study... increased the rate of both persistent and recurrent BV in their partners."

6. Clinical Implications and Conclusions

Dr. Chapa synthesizes the information, offering his clinical perspective on incorporating male partner treatment for patients with recurrent BV.

[21:45] Dr. Chapa: "For those who have recurrence, I think this is something to consider."

He acknowledges the study's limitations, including the different metronidazole dosages used compared to U.S. standards and the reliance on laboratory criteria rather than patient symptoms for defining recurrence.

[21:00] Dr. Chapa: "The primary outcome was based on lab criteria, not necessarily patient symptoms... that's something to consider."

Takeaways:

• Efficacy: Male partner treatment significantly reduces BV recurrence in women within a 12-week period.
• Applicability: While promising, this approach may be best suited for patients with recurrent BV rather than initial episodes.
• Guidelines: Current CDC recommendations do not endorse routine male partner treatment, but emerging evidence may prompt future guideline updates.
• Preventive Measures: Condom use remains a simple and effective strategy to help prevent BV recurrence.

[23:30] Dr. Chapa: "Anything that potentially give patients, especially with recurrent BV, some relief, I'm all in."

He concludes by encouraging healthcare providers to stay informed about the latest research and consider male partner treatment on a case-by-case basis for patients struggling with recurrent BV.

Notable Quotes

• On the New Study's Impact:

  "[...] the addition of oral and topical antimicrobial therapy for male partners [...] resulted in significantly lower recurrence rate over a period of 12 weeks than the recommended practice of treating women alone."
  — Dr. Chapa [15:45]

• On Clinical Application:

  "For those who have recurrence, I think this is something to consider."
  — Dr. Chapa [21:45]

• On Condom Use:

  "Condoms do have some kind of benefit in prevention of recurrent BV... a systematic review back in 2008."
  — Dr. Chapa [19:30]

Final Thoughts

Dr. Chapa emphasizes the importance of integrating new research into clinical practice thoughtfully. While treating male partners shows promise in reducing BV recurrence, it should be considered as part of a comprehensive treatment plan, especially for patients with a history of recurrent infections.

[25:10] Dr. Chapa: "We give you the big picture, not just the one puzzle piece... how medicine should work, to build each other up and encourage one another to better take care of our patients."

He reminds listeners to remain critical yet open to emerging evidence, ensuring the best outcomes for their patients.

Thank you for tuning into Dr. Chapa’s Clinical Pearls! Stay informed, stay engaged, and keep making medical education—and practice—dynamic and effective.