Many people diagnosed with a sexually transmitted disease (STD) do not have symptoms, and may not inform their past or current sexual partners of their diagnosis or routinely use condoms. Several strategies have been used to notify and treat partners of people diagnosed with an STD, but only a limited number of RCTs of their effectiveness have been undertaken.
Methods and outcomes
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of partner notification strategies in people with different STDs? What are the effects of interventions to improve effectiveness of patient referral in people with STDs? We searched: Medline, Embase, The Cochrane Library, and other important databases up to August 2008 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
We found 17 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
In this systematic review, we present information relating to the effectiveness and safety of the following interventions: contract referral; counselling (both alone and in combination with educational interventions) of index patients; educational interventions for the index patient; information for the index patient or partner; outreach assistance; patient referral; patient referral via different types of healthcare professional; patient-delivered partner therapy; patient-delivered home-sampling kits; provider referral; and reminders (any format) for the index patient.
Many people diagnosed with an STD do not have symptoms, and may not inform their past or current sexual partners of their diagnosis, or routinely use condoms.
Several strategies have been used to notify and treat partners of people diagnosed with STDs, but only a limited number of RCTs of their effectiveness have been undertaken.
Patient referral is where the index patient is encouraged to inform their past and present partners.
Provider referral is where health professionals notify the partner without disclosing the identity of the index patient, and outreach assistance is where members of an outreach team indigenous to the community notify the partner without disclosing the identity of the index patient.
Contract referral is where the index patient is encouraged to notify their partners, but the health professional does so if they fail to attend for treatment within an allotted time.
Various methods are used to improve patient referral, including: patient-delivered partner therapy; home sampling kits; information, education, reminders, and counselling for the index patient; and the use of different healthcare professionals.
Contract referral may lead to more partners of people with HIV infection being notified compared with patient referral alone.
We don't know whether provider referral or outreach assistance are beneficial in tracing partners of people with HIV.
Contract referral may increase the proportion of partners presenting for treatment compared with patient referral in people with gonorrhoea.
We don't know whether either provider referral or outreach assistance are effective partner notification strategies in people with gonorrhoea.
Provider referral may increase the proportion of partners treated compared with patient referral in people with chlamydia.
We don't know whether either contract referral or outreach assistance are effective partner notification strategies in people with chlamydia.
Contract referral strategies seem to be as effective as provider referral in people with syphilis, with similar proportions of partners of people with syphilis being notified with each strategy.
We don't know whether either patient referral or outreach assistance are effective partner notification strategies in people with syphilis.
Supplementing patient referral with patient-delivered partner therapy may reduce the risk of persistent or recurrent infection in index patients with chlamydia or gonorrhoea.
Supplementing patient referral with patient-delivered partner therapy seems to improve the proportion of partners elicited who received treatment compared with supplementation with written information for partners in people with chlamydia or gonorrhoea infections.
In people with chlamydia, home-sampling kits for partners seem to increase the number of partners who are tested for infection compared with simple patient referral.
We don't know whether supplementing patient referral with health education or counselling, either alone or in combination, for index patients improves the number of partners tested or treated.
We don't know whether adding telephone reminders plus counselling,
reminders for the index patient, or information pamphlets to patient referral improves partner notification rates, or whether different health professionals are more effective at improving patient referral rates.