Effectiveness of male partner treatment in reducing recurrence of bacterial vaginosis: a systematic review and meta-analysis

Bacterial vaginosis frequently recurs after standard antimicrobial therapy, and reinfection from untreated male partners may contribute to recurrence. We systematically reviewed studies comparing male partner treatment with placebo or no partner treatment in heterosexual couples. Of the 11 included studies, six randomised controlled trials contributed to the meta-analysis. At 4–5 weeks, all evaluable trials assessed oral-only male partner treatment, which was not associated with a significant reduction in recurrence (pooled OR 0.90, 95% CI 0.57–1.40; P = 0.63). Because trials evaluating oral-only and combined oral-topical regimens at 12–16 weeks were clinically and pharmacologically distinct, these were analysed separately: oral-only male partner treatment showed no significant benefit (pooled OR 1.17, 95% CI 0.78–1.77), whereas the single trial evaluating a combined regimen reported a significant reduction in recurrence (OR 0.31, 95% CI 0.15–0.62). Five additional studies were synthesised narratively, with qualitative findings suggesting good partner acceptability. These findings do not support routine oral-only male partner treatment. However, emerging evidence indicates that combined oral and topical treatment, targeting both urethral and penile-skin reservoirs, may substantially reduce recurrence. This distinction is biologically plausible, acceptable to couples, and clinically relevant, particularly as several guideline bodies have recently endorsed combined-regimen partner therapy. Future recommendations should differentiate regimen type, recurrence risk, and implementation feasibility rather than applying male partner treatment as a single intervention. Trial registration: PROSPERO number CRD420251111546.