Improving Partner Notification and Treatment

As discussed in Chapter 4, identification and treatment of partners is an essential component of STD clinical management because it reduces further transmission of STDs, prevents reinfection, and reduces risk of long-term complications of STDs in the infected partner. The case-finding activities of STD disease intervention specialists have been effective in containing outbreaks of bacterial STDs in discrete communities by promptly identifying and treating infected partners. In some countries, such as Sweden, partner notification for gonorrhea, syphilis, and chlamydial infection has been highly effective. However, the current methods of partner notification utilized by public STD clinics in the United States are extremely resource-intensive, inefficient, and in need of redesign. This is especially important given the high incidence of STDs among persons whose partners are unidentifiable, not easily reached, or uncooperative (and often participate in extended sexual networks).

No single model for partner notification is appropriate for all communities. One approach is to identify sex-partner networks in high morbidity areas and screen and treat members of the network. Another option is to replace the current method of notification with a combination of outreach efforts to identify partners and other individuals at high risk for STDs. The optimal combination of activities that are most effective at reaching persons at risk for STDs will vary depending on the local epidemiology of STDs, available resources, and the spectrum of local public and private health care professionals treating STDs.

STD programs need to develop new strategies and techniques for community outreach in partnership with other health care professionals rather than relying solely on health department or public STD clinic staff. It is essential that disease intervention specialists be sensitive to the local community. Other approaches include involving community-based organizations, designing and implementing outreach and screening activities, motivating private health care professionals to assist in partner notification, and assisting and motivating index patients to notify and assist their partners in seeking treatment. Limited data are available regarding the effectiveness and potential benefits of different approaches to partner notification, and further research is urgently needed to identify innovative and more cost-effective strategies for partner outreach at the individual and community levels.

As reflected in the committee's model, notifying partners of potential exposure to an STD should be a major responsibility of those persons who are infected. Community norms regarding the roles of groups or individuals in patient and partner referral need to be changed. However, health professionals need to recognize that certain individuals, especially adolescents and women, may experience difficulty notifying their partners and will require assistance in doing so. Few efforts have been made to explore the factors that affect the willingness or

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