Partner referral is the most common method of attempting to control STD spread and recurrence. Health care providers ask STD-infected patients to contact their sexual partners, inform them of their risk for infection, and encourage them to seek medical care. A second method, booklet-enhanced partner referral, also provides the patients with booklets that have referral tear-out cards for distribution to sex partners. The new method, known as patient-delivered partner treatment, gives the patient an antibiotic to offer to his partner.
To compare the efficacy of patient-delivered partner treatment with standard and booklet-enhanced partner referral, the researchers enrolled 977 men from an STD clinic in New Orleans. The men had all had a diagnosis of urethritis due to chlamydia and/or gonorrhea infection, and most reported two or more sex partners. The men were each randomly assigned to one of the three partner treatment arms. Nearly 80 percent of the patients completed a follow-up interview four weeks later, and 38 percent were re-tested for STDs.
The researchers found that about 70 percent of men in the patient-delivered partner treatment arm gave the intervention to their partners (giving antibiotics), compared with 58 percent of men in the booklet-enhanced arm (giving tear-out referral cards), and 48 percent of men in the standard p artner referral arm (telling partners to get treated). Men in the patient-delivered partner treatment arm were also less likely than men in either of the other two arms to have unprotected sex before their partners were treated for STDs. Finally, men in the patient-delivered partner treatment and booklet-enhanced arms were far less likely than men in the standard partner referral arm to re-test positive for chlamydia and gonorrhea at follow-up.
Patient-delivered partner treatment is not yet used widely due mainly to fears that are largely unfounded, said Patricia Kissinger, PhD, of Tulane University School of Public Health and Tropical Medicine and lead author of the article. "Clinicians have fears of legal liability, particularly if the partners have side effects. In three randomized trials [on patient-delivered partner treatment] that have been conducted, there have been no reports of adverse events," Dr. Kissinger said. "Particularly for chlamydia, there is little chance of side effects with azithromycin," the antibiotic given to patients in patient-delivered partner treatment.
Another worry that clinicians may have about patient-delivered partner treatment is "that partners will not get treated and counseled for other [STDs] they may have, such as HIV" if they receive treatment for chlamydia or gonorrhea, Dr. Kissinger said. "While this is a valid concern, the alternative to not doing patient-delivered partner treatment is to rely on the patient to refer the partners. We know that that results in less than 50 percent of the partners getting treated. So those partners were probably not going to get those services anyway."
The relative success of patient-delivered partner treatment probably lies in the fact that, with the more traditional methods, patients just had to admit to their partners that there was a problem. With the new method, the patients can offer their partners a solution. "The patients really like the empowerment of being abl e to give the medicine to their partners," Dr. Kissinger said. And if it helps to prevent the spread and recurrence of STDs, patient-delivered partner treatment could be a valuable tool to add to the physician's black bag.