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Review: partner notification interventions can reduce persistent or recurrent sexually transmitted infections
  1. Helen McIlveen, RGN, DN, MA
  1. Sexual Health and HIV, North Tyneside Primary Care Trust,
 Tyne and Wear, UK

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 Q In patients with sexually transmitted infections (STIs), is the addition of partner notification interventions to patient referral more effective than patient referral alone for reducing persistent or recurrent infections (PRIs)?

    METHODS

    Embedded ImageData sources:

    Medline, EMBASE/Excerpta Medica, CINAHL, Cochrane Library, PsycINFO, Sigle, and DARE (all from 1990 to 2005); 2 electronic research registers (International Standard Randomised Controlled Trial Number Register and clinicaltrials.gov); and reference lists.

    Embedded ImageStudy selection and assessment:

    randomised controlled trials (RCTs) that compared patient referral plus partner notification interventions with patient referral alone in patients with STIs. Patient referral involved index patients informing sexual partners about infections and advising them to seek treatment, with or without clinic contact cards. 14 RCTs (n = 12 389) evaluating 16 interventions met the selection criteria. STIs included gonorrhoea, chlamydia, non-gonococcal urethritis, trichomoniasis, or STI syndromes. Quality assessment of individual studies was based on randomisation, allocation concealment, fully defined outcomes, blinded outcome assessment, dropouts and withdrawals, and intention-to-treat analysis.

    Embedded ImageOutcomes:

    PRIs in index patients. Secondary outcomes included number of partners treated, tested, or notified.

    MAIN RESULTS

    Meta-analysis showed that patient-delivered partner therapy (ie, giving patients drugs for their partners) reduced PRIs among index patients and increased treatment of partners (table). 1 RCT (n = 1826, only 562 consented) found that providing index patients with chlamydia sampling kits for partners increased the proportion with >1 partner tested (22% v 10%, number needed to treat [NNT] 8, 95% CI 7 to 11) and the number of partners tested per patient (p<0.001); another RCT (n = 96) also found an increase in partners tested per patient (0.98 v 0.37). 1 RCT (n = 633) found that written information for partners reduced PRIs (5% v 12%, {NNT 14, CI 11 to 25}*) and increased the proportion of partners treated (46% v 35%, {NNT 10, CI 6 to 22}*); another RCT of 309 women with trichomonas did not find any benefits. Several trials of education or counselling for index patients showed inconsistent results in terms of rates of partner notification or treatment.

    Patient-delivered partner therapy plus patient referral v patient referral alone for sexually transmitted infections*

    CONCLUSIONS

    Patient-delivered partner therapy can reduce persistent or recurrent sexually transmitted infections. Results of individual trials showed that providing patients with sampling kits for partners increased partner testing rates. Findings for written information, education, or counselling of index patients were equivocal.

    A modified version of this abstract appears in ACP Journal Club.

    Commentary

    The systematic review by Trelle et al on partner notification of STIs identified 7 RCTs that were not included in previous reviews. The authors recommend shared responsibility with the index patient for the care of sexual partners to improve outcomes. This concept fits with other contemporary health messages around an agenda of personal responsibility in public health. It also adds to the movement to normalise management of sexual ill health and for it to be less hidden within a speciality.1

    Since World War II, robust strategies have been developed in the UK for contact tracing, using highly skilled health advisers, mostly nurses.2 Trelle et al note that this strategy tends to emphasise confidentiality of index patients and includes provider referral as an option. Given that people are more internationally mobile and report an increased number of sexual partners,3 the issue of partner notification has become more complex.

    Simply investing in communicating treatment options using contact slips with index patients led to more partners being treated, but it is puzzling that this did not lead to a reduction in PRIs in index patients. This result highlights the importance of assessing infection rates, and not just receipt of treatment, as outcomes in future trials.

    The 2007 NICE guidelines support the findings of this review and highlight the importance of one-to-one interventions by trained health practitioners, as well as investment in comprehensive partner notification strategies.4 The findings have relevance to nurses in primary and secondary health care, particularly those involved in sexual health screening programmes. If implemented, enhanced patient referral methods could provide some solutions to the complex picture of improving global sexual health.

    View Abstract

    Footnotes

    • * Calculated from data in article.

    • For correspondence: Dr N Low, University of Bern, Bern, Switzerland. low{at}ispm.unibe.ch

    • Source of funding: UK National Institute for Health and Clinical Excellence.

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