Bacterial vaginosis (BV), affecting up to 30% of young women, has a high recurrence rate, with over 50% of women experiencing reinfection within 12 weeks. The cause of BV is poorly understood, but women who report sex with a regular partner have twice the risk of those who are not sexually active. This observation has led to speculation that the condition is sexually transmitted. However, previous studies where females and their male partners were treated with oral therapy have not demonstrated a reduction in recurrence. One possible explanation for these findings is that oral therapies alone may not be sufficient to clear cutaneous penile carriage of bacterial vaginosis–associated organisms. To test this theory, Australian researchers randomized monogamous couples in which the woman had BV to female-only treatment (female-only group) or female and male partner treatment (partner-treatment group). In both groups, females received metronidazole 400 mg twice daily for 7 days or intravaginal metronidazole or clindamycin if contraindicated. In the partner-treatment group, males received the same metronidazole regimen along with 2% clindamycin cream applied to the penile skin twice daily for 7 days. During follow-up, females were tested for BV at day 8, week 4, week 8, week 12, and as needed for symptoms. At study conclusion, the primary outcome, BV recurrence within 12 weeks, was significantly lower in the partner-treatment group compared to the female-only group (35% vs 63%, p<0.001)

This study provides some insight into BV and sexual transmission. It also raises the question of whether topical therapy alone in male partners, including over-the-counter creams like Neosporin, could reduce recurrence. Lastly, it's important to note that 35% of women in the partner-treatment group had a recurrence, suggesting that some type of underlying predisposition plays a significant role in BV susceptibility.

• Male-Partner Treatment to Prevent Recurrence of Bacterial Vaginosis, NEJM (2025)
• Genitourinary infections
• Article on webpage

Spinal injections, frequently performed in pain medicine practices, are a common intervention for chronic back pain, with an estimated 9 to 11 million injections performed annually in the US alone. Despite their widespread use, studies examining their efficacy have been mixed, with placebo-controlled trials typically finding no effect. [PMID 21914755, PMID 24988555] To further explore the issue, the British Medical Journal convened a panel comprising four patients with chronic spine pain, 10 clinicians experienced in managing chronic spine pain, and eight methodologists. The group reviewed randomized controlled trials and observational studies involving spine procedures and issued the following recommendations:

• The following procedures have no proven benefit and should not be offered for radicular or axial spine pain in the cervical or lumbar region:
• Epidural injection of local anesthetic, steroids, or their combination
• Joint radiofrequency ablation with or without joint targeted injection of local anesthetic plus steroid
• Joint-targeted injection of local anesthetic, steroids, or their combination
• Intramuscular injection of local anesthetic with or without steroids
• Dorsal root ganglion radiofrequency with or without epidural injection of local anesthetic or local anesthetic plus steroids

These recommendations contradict those of the American Society of Interventional Pain Physicians (ASIPP), a professional organization that represents pain management physicians. The 2021 ASIPP guidelines strongly endorse spinal injections for treating chronic lumbar and cervical pain. In their discussion, the ASIPP authors argue that saline or short-acting local anesthetics, frequently used as controls in steroid injection studies, shouldn't be considered placebos because they have an actual therapeutic effect. They go on to contend that single-arm analysis (i.e., looking at therapies individually without comparing them to a control group) is most telling and should receive the majority of emphasis. Huh?

While it's a little comical and slightly disconcerting that a professional association would make an argument to disregard placebo controls in randomized trials, it's not surprising given that they represent doctors who put their kids through college performing these procedures. It also explains how two professional organizations can come to entirely different conclusions analyzing the same evidence. Like most things in life, all you have to do is follow the money.

• BMJ Practice Guideline on Interventional Procedures for Chronic Spine Pain (2025) [PubMed abstract]
• Low back pain review
• Article on a webpage

The FDA recently approved Journavx® (suzetrigine), a novel pain medication with a unique mechanism of action. Suzetrigine is a sodium channel blocker that selectively inhibits NaV1.8 voltage-gated sodium channels, which are expressed in peripheral sensory neurons involved in pain signaling. In a study of 1,118 patients undergoing abdominoplasty, suzetrigine demonstrated similar pain relief to hydrocodone/acetaminophen (5 mg/325 mg every 6 hours) over the first 48 postoperative hours. However, a separate similar study involving 1073 bunionectomy patients found suzetrigine to be superior to placebo but inferior to hydrocodone/APAP.

Suzetrigine's side effect profile is comparable to placebo, and no significant precautions have been identified. The recommended dosage is 100 mg once (on an empty stomach), followed 12 hours later by 50 mg every 12 hours (with or without food). Its use has not been studied beyond 14 days. Suzetrigine is a CYP3A substrate and inducer and should not be administered with strong CYP3A inhibitors. A notable interaction exists with hormonal contraceptives containing progestins other than levonorgestrel and norethindrone. The prescribing information advises that women taking these medications should use additional nonhormonal (e.g., condoms) or alternative contraceptives (e.g., combined oral contraceptives containing levonorgestrel or norethindrone) during treatment and for 28 days after discontinuation.

A novel, non-opioid pain reliever is a significant and much-needed addition. However, like all newly approved drugs, it is expensive and will likely face pushback from insurers. A study comparing it to a high-dose or potent NSAID, such as ketorolac, would be informative.

• Suzetrigine (Journavx®) review
• Opioid medications
• NSAIDs
• Article on webpage

With the publication of two recent Zepbound (tirzepatide) studies, GLP weight-loss drugs continue their streak of positive trials in obesity-related conditions. In the first study, Zepbound was compared to placebo in 731 patients with heart failure with preserved ejection fraction (HFpEF). After two years of follow-up, the absolute risk of a composite of death from cardiovascular causes or worsening heart failure was 5.4% lower in the Zepbound group (9.9% vs 15.3%). [Pubmed abstract] The second trial (N=1032), a substudy of the SURMOUNT-1 weight-loss trial, found that over 3.4 years, Zepbound significantly reduced the incidence of diabetes compared to placebo in individuals with prediabetes (1.3% vs 13.3%). [Pubmed abstract] These studies add to a growing list of trials, summarized below, where Zepbound and Wegovy (semaglutide) have been found to improve outcomes in obesity-related conditions.

• Obstructive sleep apnea (OSA): In a 52-week trial enrolling overweight adults with OSA (N=469), Zepbound significantly reduced the apnea-hypopnea index, body weight, hypoxic burden, and systolic blood pressure compared to placebo. [Pubmed abstract] In December 2024, Zepbound received FDA approval for moderate to severe OSA in adults with obesity.
• Nonalcoholic steatohepatitis (NASH): In a 52-week study (N=190) enrolling adults with NASH, more patients treated with Zepbound had NASH resolution compared to placebo (62% [15 mg dose] vs 10%) [Pubmed abstract]
• Heart failure with preserved ejection fraction (HFpEF): Like Zepbound, Wegovy has also been shown to improve HFpEF. In a 52-week study (N=529) enrolling obese adults with HFpEF, Wegovy was superior to placebo for improving heart failure symptoms and physical endurance. [Pubmed abstract]
• Secondary prevention of cardiovascular disease (CVD): In a 40-month study (N=17,604) enrolling overweight adults with a history of CVD, Wegovy was superior to placebo for reducing a composite of CVD events (6.5% vs 8%). [Pubmed abstract] Based on this study, Wegovy received FDA approval for the secondary prevention of CVD events.
• Knee osteoarthritis (OA): In a 68-week study (N=407) enrolling obese adults with moderate knee OA, Wegovy was superior to placebo for improving knee pain. [Pubmed abstract]
• Prediabetes: As discussed above, Zepbound was significantly better than placebo at preventing progression to diabetes over 3.4 years in participants with prediabetes (1.3% vs 13.3%). [Pubmed abstract]

To date, the FDA has granted two non-obesity indications for Zepbound and Wegovy: OSA for Zepbound and secondary prevention of CVD events for Wegovy. However, more are sure to come as these highly effective weight-loss drugs continue to change people's lives.

• Article on a webpage

In 2010, the ACCORD study (N=4733) was published, which found that an intensive blood pressure treatment strategy (target systolic blood pressure [SBP] < 120) did not significantly improve cardiovascular disease (CVD) outcomes compared to a standard strategy (target SBP < 140) in diabetics with hypertension. However, subsequent large trials showed that lower SBP targets (<120-130) improved CVD outcomes across a broad range of patients with and without diabetes. Given the discrepant findings, researchers decided to revisit the issue in diabetics by performing the BPROAD study, where 12,821 hypertensive type two diabetics at increased risk of CVD were randomized to an intensive (target SBP < 120) or standard (target SBP < 140) blood pressure treatment strategy; average SBP one year into the study was 122 mmHg in the intensive group and 135 mmHg in the standard group. After a median follow-up of 4.2 years, a composite of CVD events was significantly lower in the intensive group (1.65%/year vs 2.09%/year, p<0.001). [BPROAD abstract]

Contrary to the 2010 ACCORD trial, BPROAD found that a lower SBP target was beneficial in diabetics with hypertension. Possible reasons for the contradictory findings include (1) lower power in the ACCORD study due to a smaller sample size and (2) the ACCORD study design, which included another factor where patients were randomized to intensive (HgA1C < 6%) or standard (HgA1C 7 - 7.9%) glycemic targets. Other large studies, summarized below, have found that lower SBP targets modestly reduce the absolute risk of CVD events by 1 - 2% in a broad range of patients. While this effect size is small, it is meaningful when applied to large populations. Collectively, these studies support a target SBP of less than 120 mmHg in patients who can tolerate it.

• SPRINT trial (2015): The SPRINT trial (N=9361) compared a target systolic blood pressure (SBP) of <120 mm Hg to a target of <140 mm Hg in nondiabetic individuals at increased risk of CVD. The lower target reduced the incidence of a composite of CVD events by 1.6% over a median follow-up of 3.26 years (5.2% vs 6.8%, p<0.001). [PubMed abstract]
• STEP study (2021): The STEP study (N=8511) compared a target systolic blood pressure (SBP) of <130 mm Hg to a target of <150 mm Hg in Chinese patients 60 to 80 years old with hypertension. The lower target reduced the incidence of a composite of CVD events by 1.1% over a median follow-up of 3.34 years (3.5% vs 4.6%, p=0.007). [PubMed abstract]
• ESPRIT study (2024): The ESPRIT study (N=11,255) compared a target systolic blood pressure (SBP) of <120 mm Hg to a target of <140 mm Hg in Chinese patients at high risk for CVD. The lower target reduced the incidence of a composite of CVD events by 1.4% over a median follow-up of 3.4 years (9.7% vs 11.1%, p=0.028). [PubMed abstract]


• Hypertension treatment guidelines
• Article on webpage