We thank the authors for their thoughtful response to our clinical opinion.
The authors raise concerns that our clinical opinion focuses too heavily on challenges associated with male partner treatment (MPT) for bacterial vaginosis (BV) in the United States rather than the benefit of MPT to our female patients. Our clinical opinion aims to provide a realistic framework to approaching MPT in the United States, acknowledging practical (including logistical) challenges that providers on the front lines of BV care may face in their day-to-day practice when considering MPT prescription. With regard to expedited partner therapy (EPT), EPT laws vary by state, permitting clinicians to provide prescriptions for sexually transmitted infections to individuals they have not evaluated. It is important that providers understand that EPT laws currently do not extend to MPT for BV. We do not suggest that the lack of EPT laws for MPT precludes providers from prescribing MPT if a patient-physician relationship has been established between the male partner and the healthcare provider. The authors further suggest telehealth with male partners or couples as one approach to providing MPT. We agree, providers may incorporate MPT into their practices as with telehealth as a potential strategy. Whether care is provided in-person or via telemedicine, there should be consideration of patient confidentiality, particularly if the same provider is seeing both partners. Clinicians should be careful to avoid disclosure of one partner’s medical information to another, unless permission has been given. Further research is needed to identify the most effective strategies for implementing MPT in the United States.
With regard to benefits, we agree counseling should be nuanced, balanced, and cover the potential impact of treatment on both partners to enable informed patient decision-making. When discussing potential benefit for female partners, it is important to set expectations with regard to the 35% BV recurrence rate in the treatment arm of the StepUp trial and to cover current unknowns: including MPT efficacy past 12 weeks, the magnitude of impact in US populations, and the relative contribution of sexual transmission to BV recurrences for the individual patient. Nuanced, sensitive counseling can acknowledge concepts of shared responsibility and the burden of recurrent BV borne by women while not neglecting the responsibility to disclose potential side effects (even if mild) and the reality of limited benefit to the male partner.
G.M.Y and K.A.W report no conflicts of interest. K.G.G. receives royalties from UpToDate. S.T. has been a consultant for Luca Biologics, receives royalties from UpToDate, and participates in research supported by in-kind donation of test kits from Hologic.
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