Just as couples adopt each other’s social circles, musical tastes and catchphrases, so, too, do their microbial worlds come to resemble one another.
“You get bodies close to each other, that’s what happens,” said Dr. Jeanne Marrazzo, a leading vaginal microbiome researcher, who first identified the bacteria associated with bacterial vaginosis.
The emerging understanding that male sexual partners can transfer B.V. to their female partners raises tricky questions about how to manage the condition — and what male partners can do to help. Medical guidelines are still evolving, but we asked three sexual health experts what you and your partner can do if you are diagnosed.
Should I tell my regular male partner if I test positive?
The point of notifying partners about S.T.I.s is twofold: to protect yourself from re-infection and to stop an infection from spreading throughout the community. In the case of B.V., doctors now know that treating partners helps women with the infection beat the condition in the long run, providing evidence that it can be transmitted sexually.
If you have had more than one episode of B.V., the diagnosis is worth bringing up with your partner, especially now that there is something you can do about it, said Dr. Sarah Cigna, a gynecologist who runs a sexual health clinic at George Washington University.
It is still unclear whether treating a partner is warranted — or effective — if it is a woman’s first outbreak of B.V. If a woman has a case of bacterial vaginosis that clears up within weeks, Dr. Cigna said, she would consider watching and waiting before bringing it up in the context of partner treatment.
What is partner treatment?
Men whose female partners are being treated for B.V. can now ask their doctor to be treated with antibiotics at the same time. Here’s how it works: For one week, both partners take antibiotics and abstain from any sexual activity. Male partners both take an oral antibiotic and apply a topical antibiotic cream to their penis twice a day.
However, unless a male partner goes to a sexual health expert or S.T.I. clinic, he may encounter a doctor who has never heard of partner treatment. It may help to bring along a copy of the new guidelines for partner treatment from the American College of Obstetricians and Gynecologists, a study published in March in the New England Journal of Medicine or the new Australian S.T.I. guidelines to bring them up to speed.
Partner treatment has only been shown to be effective if a relationship is closed. But from a public health standpoint, if a male partner has other female partners, it may be even more important to notify them, Dr. Cigna said.
What else can male partners do?
Use condoms. Studies show that consistent condom use helps prevent B.V. from developing or returning. Before the March study, a common explanation was that semen could disturb the vaginal pH, leaving the microbiome more vulnerable to being overtaken by unwanted microbes. Now, many doctors think it is likely that barriers prevent certain bacteria from being swapped back and forth.
There is no male test for B.V., meaning that there is no way to know for sure whether a man is carrying B.V.-associated bacteria. But condoms can still help. In a closed relationship, partners can consider incorporating condoms consistently, if it makes sense for them. If the relationship is not closed, condoms can help a male partner protect other female partners from acquiring or developing the condition. (Note that antibiotic cream can weaken condoms for up to three days.)
What about female partners?
In the 1990s, Dr. Marazzo’s research was already showing that the vaginal microbiomes of women in sexual partnerships with women tended to mirror each other; if one partner had B.V., the other was likely to as well. This was a critical piece of evidence that B.V. could be sexually transmitted, but at the time, most researchers were not considering the role of female-female transmission. “If there’s not a penis involved, then it isn’t really sex, right?” Dr. Marrazzo said.
Studies have not yet shown that simultaneous treatment can help prevent recurrence in same-sex female couples. But, anecdotally, many clinicians say it does. If you find out that you have B.V. and have a female partner, it is worth asking your gynecologist whether they recommend that she be tested and treated. Dr. Bradshaw is currently recruiting LGBTQ couples for a partner treatment trial, in an effort to discover whether partner treatment works for gender-diverse partners.
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