Improved effectiveness of partner notification for patients with sexually transmitted infections: systematic review

Objective To examine the effectiveness of methods to improve partner notification by patient referral (index patient has responsibility for informing sex partners of their exposure to a sexually transmitted infection). Design Systematic review of randomised trials of any intervention to supplement simple patient referral. Data sources Seven electronic databases searched (January 1990 to December 2005) without language restriction, and reference lists of retrieved articles. Review methods Selection of trials, data extraction, and quality assessment were done by two independent reviewers. The primary outcome was a reduction of incidence or prevalence of sexually transmitted infections in index patients. If this was not reported data were extracted according to a hierarchy of secondary outcomes: number of partners treated; number of partners tested or testing positive; and number of partners notified, located, or elicited. Random effects meta-analysis was carried out when appropriate. Results 14 trials were included with 12 389 women and men diagnosed as having gonorrhoea, chlamydia, non-gonococcal urethritis, trichomoniasis, or a sexually transmitted infection syndrome. All studies had methodological weaknesses that could have biased their results. Three strategies were used. Six trials examined patient delivered partner therapy. Meta-analysis of five of these showed a reduced risk of persistent or recurrent infection in patients with chlamydia or gonorrhoea (summary risk ratio 0.73, 95% confidence interval 0.57 to 0.93). Supplementing patient referral with information for partners was as effective as patient delivered partner therapy. Neither strategy was effective in women with trichomoniasis. Two trials found that providing index patients with chlamydia with sampling kits for their partners increased the number of partners who got treated. Conclusions Involving index patients in shared responsibility for the management of sexual partners improves outcomes. Health professionals should consider the following strategies for the management of individual patients: patient delivered partner therapy, home sampling for partners, and providing additional information for partners.

[1]  Kenneth F. Schulz,et al.  The CONSORT Statement , 1996 .

[2]  F. Olesen,et al.  Urogenital Chlamydia trachomatis infections in general practice: diagnosis, treatment, follow-up and contact tracing. , 1998, Family practice.

[3]  N. Laird,et al.  Meta-analysis in clinical trials. , 1986, Controlled clinical trials.

[4]  D. Mercey,et al.  Investigation into the acceptability and effectiveness of a new contact slip in the management of Chlamydia trachomatis at a London genitourinary medicine clinic , 2002, Sexually transmitted infections.

[5]  A. Oxman,et al.  Strategies for partner notification for sexually transmitted diseases. , 2001, The Cochrane database of systematic reviews.

[6]  N. Low,et al.  Global control of sexually transmitted infections , 2006, The Lancet.

[7]  D. Mabey,et al.  Partner notification for the control of sexually transmitted infections , 2003, BMJ : British Medical Journal.

[8]  J. S. St. Lawrence,et al.  STD screening, testing, case reporting, and clinical and partner notification practices: a national survey of US physicians. , 2002, American journal of public health.

[9]  Anne M Johnson,et al.  Trends in sexually transmitted infections in general practice 1990-2000: population based study using data from the UK general practice research database , 2006, BMJ : British Medical Journal.

[10]  J. Sterne,et al.  Partner notification of chlamydia infection in primary care: randomised controlled trial and analysis of resource use , 2005, BMJ : British Medical Journal.

[11]  Helen McIlveen.  Review: partner notification interventions can reduce persistent or recurrent sexually transmitted infections , 2007, Evidence-based nursing.

[12]  D. Moher,et al.  The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials. , 2001, Journal of the American Podiatric Medical Association.

[13]  I. Olkin,et al.  Improving the quality of reporting of randomized controlled trials. The CONSORT statement. , 1996, JAMA.

[14]  K. Fenton,et al.  Divergent Approaches to Partner Notification for Sexually Transmitted Infections Across the European Union , 2005, Sexually Transmitted Diseases.

[15]  K. Radcliffe,et al.  Patient preferences for partner notification , 2006, Sexually Transmitted Infections.

[16]  H. Handsfield,et al.  Expedited partner therapy in the management of sexually transmitted diseases; review and guidance , 2006 .

[17]  M. Golden,et al.  Patient-Delivered Partner Therapy for Sexually Transmitted Diseases as Practiced by U.S. Physicians , 2005, Sexually transmitted diseases.

[18]  A. Walker,et al.  Improving the quality of reporting in randomised controlled trials. , 2004, Journal of wound care.

[19]  N. Low,et al.  Developing national outcome standards for the management of gonorrhoea and genital chlamydia in genitourinary medicine clinics , 2004, Sexually Transmitted Infections.

[20]  A. Oxman,et al.  Partner notification for sexually transmitted diseases: an overview of the evidence. , 1994, Canadian journal of public health = Revue canadienne de sante publique.

[21]  D. Altman,et al.  Measuring inconsistency in meta-analyses , 2003, BMJ : British Medical Journal.

[22]  B. A. Macke,et al.  Partner notification in the United States: an evidence-based review. , 1999, American journal of preventive medicine.

[23]  M. Hogben,et al.  Physicians’ opinions about partner notification methods: case reporting, patient referral, and provider referral , 2004, Sexually Transmitted Infections.