The bacterium Gardnerella Vaginalis (G.V.) is widely known for its association with Bacterial Vaginosis (BV), a common condition affecting women. While the focus remains on female reproductive health, the organism also plays a significant role in the health of men, particularly as a factor in sexual transmission. Understanding the presence and impact of G.V. in men is important for effective treatment and the prevention of recurrent infections in their female partners.
What is Gardnerella Vaginalis
Gardnerella Vaginalis is a facultative anaerobic bacterium associated with Bacterial Vaginosis (BV), which involves an imbalance in the vaginal microbiome. While typically present in low concentrations, its overgrowth is characteristic of BV. Although not classified as a traditional sexually transmitted infection (STI), its presence is strongly linked to sexual activity and transmission.
The organism is passed to men through unprotected sexual contact with an infected partner, leading to colonization in the male genitourinary tract, particularly the urethra. Male partners of women diagnosed with BV frequently test positive for the bacterium, highlighting its role in the recurrence cycle. Its persistence in men is thought to create a reservoir that can lead to the reinfection of a female partner.
Recognizing Symptoms in Men
The majority of men who carry Gardnerella Vaginalis are asymptomatic. This asymptomatic carriage poses a challenge for diagnosis and interrupting transmission cycles, as men may unknowingly harbor the organism. When symptoms do manifest, the presentation is typically mild and localized to the genitourinary system.
The most common symptomatic presentation is non-gonococcal urethritis, which is inflammation of the urethra. This may involve a thin, clear, or whitish discharge from the penis, though this discharge is often subtle. Men might also report mild irritation, itching, or a burning sensation during urination (dysuria). In rare instances, the infection can progress to balanoposthitis (inflammation of the foreskin and glans), cystitis, or prostatitis.
Diagnostic Procedures for Men
Diagnosis of Gardnerella Vaginalis in men is typically pursued if the man presents with urethral symptoms or if his female partner experiences recurrent BV. The diagnostic process begins with collecting a sample from the genitourinary tract, usually a urine sample or a urethral swab. A first-catch urine sample is often used because it captures cells and discharge from the urethra.
The primary laboratory technique for identifying G.V. is the Polymerase Chain Reaction (PCR) test. PCR assays are highly sensitive and detect the bacterial DNA, improving upon older methods like culture or Gram staining. Multiplex PCR tests are valuable because they can detect G.V. alongside other sexually transmitted organisms, which is important since G.V. frequently occurs as part of a polymicrobial infection. Quantitative PCR can also assess the bacterial load.
Treatment and Partner Notification
Treatment for symptomatic Gardnerella Vaginalis infection in men involves a course of oral antibiotics. The most frequently prescribed drug is metronidazole, typically given as a 500 mg dose twice daily for seven days.
Clindamycin (300 mg orally twice daily for seven days) is an alternative, especially if the patient has an allergy or intolerance to metronidazole. Patients taking metronidazole must avoid alcohol entirely during treatment and for 24 hours afterward due to the risk of a disulfiram-like reaction. Treatment is often recommended even for asymptomatic male partners when the female partner experiences frequent recurrence of BV. Treating the male partner eliminates the organism from the urethra, preventing reintroduction and breaking the cycle of infection.
Strategies for Prevention
Preventing the acquisition and transmission of Gardnerella Vaginalis centers on adopting safer sexual health practices. Consistent and correct use of barrier methods, such as condoms, during sexual intercourse significantly reduces the risk of transmission.
Reducing the number of sexual partners also lowers the likelihood of encountering and transmitting the bacterium. Maintaining good general genital hygiene, including gently washing the area with mild soap and water, is helpful. If a man’s sexual partner is diagnosed with BV, she must complete her prescribed treatment fully. The couple should also discuss the potential need for the male partner to be tested and treated.