This treatment plan reviews the risks and benefits of the treatment we are recommending. Please make sure to read it and the manufacturer's pamphlet that comes with the medicine. The manufacturer's pamphlet contains full information on potential medication interactions, side effects, and other important information you should know about the medicine before you start.

Instructions

This treatment recommendation is for patients assigned male at birth who are in an ongoing heterosexual sexual relationship, with a partner assigned female at birth who is receiving prescription treatment or a confirmed current diagnosis for bacterial vaginosis. You have stated that you wish to obtain prophylactic male treatment for Bacterial Vaginosis (BV) prevention in your partner with topical Clindamycin 2% AND oral Metronidazole 500mg. You are to take oral Metronidazole 500mg twice daily for 7 days along with Topical Clindamycin 2% cream 2.5g topically to the external penile skin twice daily for 7 days. Both of these treatments should be taken together simultaneously for the full 7 days.

Your Clindamycin 2% cream will come with 5 applicators, however use will be for 7 days. Wash hands before and after use. Fill the applicator with the prescribed amount of cream. Ensure to wash hands before and after your topical Clindamycin application. Avoid contact with any broken or irritated skin. Wash the applicator with warm soapy water and rinse well to allow reuse (do not use hot or boiling water). Use the amount as directed for the complete length of time prescribed. Topical Clindamycin can weaken condom use. Barrier contraceptives are not recommended concurrently. You should avoid intercourse during treatment.

Note: Your Clindamycin cream may read “intravaginal.” Please note that this treatment is reflective of the research noted below with standard US dosing and is being used off-label for treating external genitalia in males.

Additional research in a peer-reviewed medical journal has recently been released showing this combined oral and topical antimicrobial therapy for male partners in addition to first-line treatment of women for bacterial vaginosis that resulted in a lower rate of recurrence of bacterial vaginosis within 12 weeks compared to standard antibiotic care delivered to females alone.

It is important to note that while this research references Metronidazole 400mg as the standard dosage recommendation in Australia, the standard U.S. dosage is 500mg.

While this treatment is not yet recognized as standard care, Wisp has chosen to offer this treatment option, as prescribed by your prescriber based on his or her clinical judgment, based on the potential benefits of Metronidazole and Clindamycin in patients assigned male at birth. This decision reflects Wisp's commitment to advancing women’s health, improving access to treatment, and advocating for improved care outcomes. We will continue to monitor emerging data to ensure safe and effective treatment options.

Please note: Metronidazole has a black box warning issued by the FDA that it has been shown to be carcinogenic in mice and rats and is recommended against “unnecessary use”. For this reason this treatment is reserved only once every 3 months for patients assigned male at birth.

Allergies

This medicine, like all medications, may cause an allergic reaction if you are allergic to similar medicines or components. If you are allergic to any of the following please do not take the medicine and call or message us or see your doctor in person.

Metronidazole

• Metronidazole
• Nitroimidazole derivatives, or any component of the formulation
• Use of disulfiram within the past 2 weeks
• Use of alcohol or propylene glycol during therapy and for 24 hours after therapy
  

Clindamycin

• Clindamycin
• Lincomycin
• Cleocin
  
  

Conditions

We have evaluated your health history and the specific health information you provided us, however if anything changes and you develop one of these conditions, please stop taking this medicine and call or message us immediately. This list may not be all inclusive.

Metronidazole

• Cockayne syndrome
• Use of alcohol or Antabuse
• Central nervous system problems
• Liver problems
• Seizure disorders
• Kidney problems
• Blood disorders- clotting, formation, etc.
  

Clindamycin

• Liver problems
• Blood disorders
• Antibiotic associated colitis
• History of regional enteritis
• History of Ulcerative Colitis
  
  

Pregnancy and Breastfeeding

This treatment is for patients assigned male at birth.

We do not provide treatment to pregnant patients on our platform and recommend seeking care with their OB/GYN for continued care throughout the pregnancy for the patient and baby’s safety.

Emergency Side Effects

This medicine can cause dangerous and potentially life-threatening side effects. If any of the emergency side effects listed in the manufacturer’s pamphlet or those below happen to you please stop taking the medicine and call 911 or seek immediate medical help in person.

• Sudden onset of chest pain
• Shortness of breath
• Difficulty or painful swallowing
• Severe skin rash and/or itching
• Facial or throat swelling
• Blurred vision
• Severe bloody or passing mucus in the diarrhea
  
  

Other Side Effects

This medicine can also cause other side effects including (this list is not all inclusive):

Metronidazole

• Nausea and vomiting
• Abdominal discomfort
• Diarrhea
• Metallic taste in the mouth
• Genital itching or irritation
• Headache
• Subsequent skin yeast infection
• Flu-like symptoms
• Sore throat
• Decreased libido
• Mood changes
• Nasal congestion
• Dark red urine
  

Clindamycin

• Burning sensation or redness of the skin where applied
• Dryness of the skin where applied
• Itching of the skin where applied
• Irritation of the skin where applied
• Headache
• Dizziness
• Fatigue
• Abdominal discomfort
• Darrhea
• Nausea and vomiting
• Passing gas
• Eye discomfort
  
  

Medicines, Supplements, and Foods

We have evaluated the specific health information you provided us, however if you are taking any of the medicines, foods, or supplements listed below call or message us before you take the medicine. Some of these can cause dangerous interactions with the medicine we are prescribing you and we will help you evaluate that risk and decide on an appropriate treatment plan. Please ensure your chart is up to date with your current medications, allergies, and medical conditions so your provider can safely treat you as this list may not be all inclusive.

Metronidazole

• Alcohol
• Disulfiram
• Warfarin or other blood thinners
• Lithium
• Phenytoin
• Phenobarbital
• Phenytoin
• Primidone
• Medications that can affect your heartbeat
• Tipranavir
• Sulfonylureas
  

Clindamycin

• Neuromuscular blocking agents
• Erythromycin
  
  

Risks

Accurate Information

We have evaluated your health history and your specific health information you provided and determined it is safe to proceed with this treatment at this time. If your health history changes including diagnoses or medications please message or call us before you take the medicine to ensure it's safe to proceed. Some medications and conditions can cause dangerous interactions with the medicine we are prescribing and we will help you evaluate that risk and decide on an appropriate treatment plan.

Treatment Failure

This treatment is not guaranteed to be effective. It may not work or may only partially resolve the condition for which you are seeking treatment. If the treatment is not working, or if you are experiencing new or worsening symptoms, give us a call or message us anytime. If it is an emergency, call 911 or seek immediate medical help in person. You may need to seek alternative treatment such as those listed below or in the follow up plan.

Misdiagnosis or Delayed Diagnosis

Through telehealth, there is also a risk that we misdiagnose or fail to diagnose conditions that you may have which could affect our recommendation for treatment. This risk exists with a doctor in person as well but they may have additional resources to aid their evaluation. We use evidence-based practice and guidelines as well as clinical decision-making to minimize these risks.

Accepting or Declining Our Recommendation

We have based our recommendation on your specific case and medical guidelines, but there may be alternative treatments or strategies that may be helpful to you. Some may be more or less effective than what we provide. Some treatments may require an in-person exam or procedure which we can’t provide. Message us or talk to your doctor in person to discuss alternative treatments.

Share with Your In-Person Healthcare Team

You can access your records anytime. We strongly recommend that you update your in-person doctor, pharmacist, and the rest of your healthcare team to let them know about any new medicines you are taking or other changes in your health.

You can also ask us questions anytime and we are happy to help you share any information about your health with your in-person healthcare team.