Yazdy et al’s commentary raises several valid points regarding limitations of current data supporting male partner treatment (MPT) for bacterial vaginosis (BV), but overlooks the physical, social, and economic burden of BV on women and focuses too heavily on the challenges of MPT.
The American College of Obstetricians and Gynecologists clinical practice update recommends consideration of concurrent sexual partner therapy with oral and topical antibiotics for male sexual partners of adults with recurrent, symptomatic BV. This change in guidance was informed by the StepUp trial, which demonstrated a 35% BV recurrence rate with MPT, compared to 63% without. Yazdy et al cite ethical complexities, risks to male partners, and treatment logistics as major challenges to MPT.
Although male partners do not derive a direct biomedical benefit from treatment, the ethical framing of MPT should also consider psychosocial and relationship well-being. StepUp studies indicate that many men experienced partner treatment as a positive bonding experience that strengthened communication, reinforced commitment, and reflected shared responsibility for sexual health. While the authors noted a 45% rate of mild side effects, they failed to mention the higher rate and repeated occurrence of these side effects among female partners being treated for recurrent BV. This emphasis fails to center our female patients at the forefront.
Furthermore, the authors highlight expedited partner therapy (EPT) as a possible challenge given variations in state laws and infection type. While EPT statutes do not extend to BV, the absence of EPT-specific authorization should not be conflated with legal prohibition or heightened liability for partner therapy, if a patient-physician relationship has been established. EPT laws do not uniformly protect clinicians, even for established STIs. Additionally, Yazdy et al do not offer any recommendations to expand EPT through advocacy or alternative pathways to promote partner therapy, like telehealth appointments with male partners or couples.
We agree with Yazdy et al that US studies on male partner treatment for BV are needed. However, the feasibility of such studies remains limited by funding constraints and minimal industry investment in BV research. Therefore, clinical decisions must be made based on available evidence. Given StepUp findings, American College of Obstetricians and Gynecologists guidance, and increasing patient interest, male partner treatment will likely integrate into clinical practice more often. While we appreciate the author’s attention to this topic, a more balanced review, emphasizing the impact of treatment on both partners, is necessary to guide shared decision-making, considering the limited data.
The authors report no conflict of interest.
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