There is limited evidence about the most effective partner notification strategies for people with sexually transmitted diseases
- Volmink, Jimmy MD, PhD, MPH
BACKGROUND
Strategies for contacting the partners of people with a sexually transmitted disease include patient referral, conditional referral and provider referral. The benefits of each strategy are unclear. Previous reviews were prior to AIDS, included poorly designed studies or focused only on developed countries.
OBJECTIVE
To review the effectiveness of provider, contract and patient referral strategies for contacting the partners of people with sexually transmitted diseases.
METHOD
Systematic review.
LITERATURE REVIEW
EMBASE, MEDLINE, Psychological Abstracts, Sociological Abstracts, Cochrane Controlled Trials Register, proceedings of the International AIDS conferences and the International Society for STD Research meetings were searched.
INCLUSION/EXCLUSION CRITERIA
Randomised controlled trials comparing two or more partner notification strategies were eligible. Sexually transmitted diseases included gonorrhoea, chlamydia, trichomonas, syphilis, chanchroid, genital herpes, human papillomavirus, Hepatitis B, HIV, uretheral discharge syndrome in men, epididymitis, lower genital tract syndrome, pelvic inflammatory disease and genital ulcer syndrome. Exclusion criteria were not provided. Eleven trials with 8014 participants were included (two with HIV-positive people). Eight of the trials were in the United States, one in Denmark, one in South Africa and one in Zambia.
OUTCOMES
Partners sought, located, notified and presenting for care; partners testing positive and treated; patient re-infection rates; sexually transmitted disease incidence; behavioural and attitudinal changes.
MAIN RESULTS
Provider referral may increase the number of partners presenting for evaluation. Having a choice between patient and provider referral also increases partner notification compared to patient referral alone. Verbal patient education slightly increased the number of partners presenting for care.
AUTHORS' CONCLUSIONS
There is no strong evidence of the most effective partner notification strategy. Notification by providers appears more effective than patient referral. Interventions combining provider training with patient education and interventions in developing countries need to be evaluated further. Harms should also be measured.
NOTES
Design, validity and methodological rigour varied between studies. Cultural differences complicate assessment of the most effective method of partner notification.