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Public health issues

Partner notification

Surveys in the United Kingdom and elsewhere suggest that more people have more sexual partners than ever before [Graham, 2004]. More than half the partners of positive patients are themselves positive [Mardh, 2002].Screening and treating infections in men is one way of preventing their female sex partners from becoming reinfected. Howell et al., 1997 used a decision model to compare the cost-effectiveness of early diagnosis and treatment of the female sex partner herself (strategy 1) versus diagnosis and treatment of infection in their male sex partners (strategy 2) versus with no partner notification. The outcomes were the number of cases of pelvic inflammatory disease prevented and or the net costs expended. In a hypothetical cohort of 1,000 male and 1,000 female index patients, strategy 1 prevented 64 cases of pelvic inflammatory disease at a saving of $247,000 while strategy 2 saved $33,000 over no partner notification. Sensitivity analysis showed that strategy 1 was cost-effective across a wide range of assumptions whereas, although strategy 2 was cost-effective at baseline, its cost-saving ability was subject to changes in the model. It was concluded that partner notification of both male and female index patients is a cost-effective public health strategy for the prevention of pelvic inflammatory disease and that, in most settings, both strategies should be implemented [Howell et al., 1997]. Clad et al., 2001 found that when both partners in a sexual relationship were tested, the detection rate increased from 54% (female only) to 81% (both partners). Model-based studies also support the value of screening all sexual partners in reducing the prevalence of infection [Kretschmar et al., 2001]. However partner notification is often performed in a half-hearted manner and there are significant organisational problems [Mardh, 2002;  Maheux et al., 1995]. Partner notification can be done in a variety of settings, include primary medical care and family planning clinics, but it needs to be done by trained persons in a confidential and non judgmental manner [Graham, 2004]. It is therefore not surprising that, in the UK at least, most primary care physicians would prefer specialist sexual health clinics to undertake partner notification [Joshi & Dixon, 2000]. Partner notification strategies may be usefully combined with patient delivered therapy [Klausner & Chaw, 2003].

[MEW] July 2004

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References

Clad, A., Prillwitz, J., Hintz, K. C., Mendel, R., Flecken, U., Schulte-Monting, J. & Petersen, E. E. (2001). Discordant prevalence of chlamydia trachomatis in asymptomatic couples screened using urine ligase chain reaction. European Journal of Clinical Microbiology and Infectious Diseases 20, 324 - 328.

Graham, A. (2004). Sexual health. British Journal of General Practice 54, 382 - 387.

Howell, M. R., Kassler, W. J. & Haddix, A. (1997). Partner notification to prevent pelvic inflammatory disease in women. Cost-effectiveness of two strategies. Sexually Transmitted Diseases 24, 287 - 292.

Joshi, U. Y & Dixon, W. (2000). General practioners' views on the screening for genital Chlamydia trachomatis infection and partner notification. International Journal of STDs and AIDS 11, 588 - 591.

Klausner, J. D. & Chaw, J. K. (2003). Patient-delivered therapy for chlamydia: putting research into practice. Sexually Transmitted Diseases 30, 509 - 511.

Maheux, B., Haley, N., Rivard, M. & Gervais, A. (1995). STD risk assessment and risk-reduction counseling by recently trained family physicians. Academic Medicine 70, 726 - 728.

Mardh, P-A. (2002). Is the prevention of genital chlamydial infections by community involvement possible? Best Practice and Research in Clinical Obstetrics and Gynaecology 16, 829 - 846. [Useful review based on Swedish experience]. Full article

_{Kretschmar, M., Welte, R., van den Hoek, A. & Postma, M. J. (2003). Comparative model-based analysis of screening programs for Chlamydia trachomatis infections. American Journal of Epidemiology 153, 90 - 101.}