Male Partner Treatment for Bacterial Vaginosis: A Systematic Review and Meta-Analysis of Randomized Trials.

Abstract

Bacterial vaginosis (BV) is the commonest vaginal infection globally, resulting from a shift from Lactobacillus-dominant microbiota to an overgrowth of anaerobes. Although standard antibiotic therapy achieves short-term cure, recurrence remains high. Recent evidence suggests that male genital microbiota is a potential reservoir for BV-associated bacteria (BVAB), prompting investigation into the role of concurrent male partner treatment (MPT). We conducted a systematic review and meta-analysis of randomized controlled trials to assess the effect of MPT on BV recurrence and cure. The study followed Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines and was registered in PROSPERO (CRD420251132582). Embase, Scopus, Google Scholar, and PubMed databases were searched independently, from 1980 to September 2025. Pooled risk ratios (RR) and 95% confidence intervals (CI) were calculated using random-effects models. Risk of bias and certainty of evidence were assessed using RoB 2 and GRADE. Eight randomized controlled trials were included. MPT showed no significant effect on BV recurrence (RR 0.92; 95% CI 0.69-1.23; I2 = 64%) or cure rate (RR 1.01; 95% CI 0.94-1.07; I2 = 46%). Adverse events were mild and similar across groups (RD 0.04; 95% CI 0.02-0.11). However, lower recurrence was observed among fully adherent couples, particularly in a recent trial using combined oral and topical therapy. While the overall pooled effect of routine partner treatment is neutral, a benefit may exist among fully adherent couples receiving intensive regimens. Targeted approaches that optimize regimen intensity and adherence warrant further investigation.