STD Quarterly
Informing partners can help lower STD rates
What is your approach when it comes to treatment of partners of patients with sexually transmitted diseases (STDs)? A new research analysis indicates that patient-delivered partner therapy (PDPT) and home sampling for partners can be effective management strategies to reduce STD occurrence in partners of patients with an existing infection.1
Providers often may rely on simple patient referral in which patients are encouraged to tell their partners to seek treatment. Such an approach may not be effective; research indicates that only 40%-60% of named sexual partners are reached by such methods.2
Secrecy, stigma, and blame
The cultures of secrecy, stigma, and blame that surround sexually transmitted infections make it difficult to deal with them effectively, says Nicola Low, MD, FFPH, reader in epidemiology and public health in the Department of Social and Preventive Medicine at the University of Bern, Switzerland, and a co-author of the current analysis. Having hard evidence that shows the benefits of open and informed discussion should help to destigmatize sexually transmitted infections and improve sexual health, Low states.
Researchers participating in the analysis wanted to look at new innovations in partner notification, says Low. The basic model of patient referral, in which a clinician tells the patient with a sexually transmitted infection that it is important that their sexual partners get treated is really not very successful in practice, she states.
To perform the analysis, researchers identified 14 studies involving 12,389 women and men diagnosed with a common sexually transmitted infection, including chlamydia, gonorrhea, and nonspecific urethritis. "We found three interventions that improve the success of patient referral: PDPT, giving the patient urine sampling kits to give to their partners, and giving the patient written information that they can give to their partners," states Low. "The interesting thing about these three interventions is that all of them make it easier for the patient to contact their partners and talk about the infection."
EPT gaining ground
Expedited partner therapy (EPT), the practice of treating sex partners of STD patients without an intervening medical evaluation or professional prevention counseling, is gaining ground as an effective option in STD treatment. Patient- delivered partner therapy, the most recognized form of EPT, has been spotlighted by the Centers for Disease Control and Prevention (CDC) as an option in partner treatment, particularly for male partners of women with chlamydia or gonorrhea.
Research shows that expedited partner care can decrease the patient's risk of reinfection and increase the number of treated partners.3-5 In August 2006, CDC recommended the practice of EPT for certain populations and specific conditions in its updated STD Treatment Guidelines.6
Overcoming legal obstacles
Providers may face legal roadblocks within their scope of practice when it comes to EPT. To assist state and local STD programs to implement EPT as a partner management tool, the CDC, the Center for Law and the Public's Health at Georgetown University, and Johns Hopkins University have worked together to assess the legal framework concerning EPT, says John M. Douglas Jr., MD, director of the CDC's Division of STD Prevention. The group had two goals in mind in undertaking the project, says Douglas. The first objective was to provide state and local public health partners with a tool to help them work with such local legal counsel as in-house counsel, attorneys general, and city attorneys, to understand and address potential legal barriers to EPT implementation. The second objective was to provide state and local public health partners with information about the EPT legal landscape in other jurisdictions to facilitate collaboration and encourage sharing of lessons learned, he notes.
The CDC has developed state-specific information on its web site, www.cdc.gov/std/ept. At the current time, EPT is permissible in 11 states: California, Colorado, Minnesota, Mississippi, Nevada, New Mexico, Pennsylvania, Tennessee, Utah, Washington, and Wyoming. States with laws that currently prohibit EPT include Arizona, Arkansas, Florida, Illinois, Kentucky, Louisiana, Michigan, North Dakota, Ohio, Oklahoma, South Carolina, West Virginia, and Vermont. EPT is possible in the remaining 28 states, according to the web site.
References
- Trelle S, Shang A, Nartey L, et al. Improved effectiveness of partner notification for patients with sexually transmitted infections: Systematic review. BMJ 2007; [Epub ahead of print].
- Low N, Welch J, Radcliffe K. Developing national outcome standards for the management of gonorrhoea and genital chlamydia in genitourinary medicine clinics. Sex Transm Infect 2004; 80:223-229.
- Schillinger JA, Kissinger P, Calvet H, et al. Patient-delivered partner treatment with azithromycin to prevent repeated Chlamydia trachomatis infection among women: A randomized, controlled trial. Sex Transm Dis 2003; 30:49-56.
- Golden MR, Whittington WL, Handsfield HH, et al. Effect of expedited treatment of sex partners on recurrent or persistent gonorrhea or chlamydial infection. N Engl J Med 2005; 352:676-685.
- Kissinger P, Mohammed H, Richardson-Alston G, et al. Patient-delivered partner treatment for male urethritis: A randomized, controlled trial. Clin Infect Dis 2005; 41:623-629.
- Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2006. MMWR 2006; 55(RR-11):40.
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