Improved effectiveness of partner notification for patients with sexually transmitted infections: systematic reviewBMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39079.460741.7C (Published 15 February 2007) Cite this as: BMJ 2007;334:354
- Sven Trelle, research fellow1,
- Aijing Shang, research fellow1,
- Linda Nartey, specialist registrar1,
- Jackie A Cassell, honorary senior clinical research fellow2,
- Nicola Low, reader in epidemiology and public health1
- 1Department of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, Bern, CH-3012, Switzerland
- 2Centre for Sexual Health and HIV Research, Royal Free and University College Hospitals Medical School, London
- Correspondence to: N Low
- Accepted 6 December 2006
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.
Contributors: ST searched the literature, selected articles, extracted and analysed the data, and drafted the manuscript. AS selected articles, extracted the data, and revised the manuscript. LN selected articles and revised the manuscript. JAC obtained funding, retrieved the data, and revised the manuscript. NL obtained funding, supervised the review, revised the manuscript, and is guarantor for the paper. All authors approved the final version.
Funding: ST, AS, LN, and NL are or were employed by the University of Bern, which received funding from the UK National Institute for Health and Clinical Excellence. Parts of the research referred to in this article were commissioned by NICE to inform the development of its forthcoming guidance on the prevention of sexually transmitted infections. The full report is available on www.nice.org.uk/page.aspx?o=371771. The opinions expressed in the article are those of the authors and not the institute. This article does not constitute NICE guidance. The funding source had no role in the conduct or analysis of the study and no influence on the decision to publish the results. All authors had full access to all data of the study.
Competing interests: None declared.
Ethical approval: Not required.
- Accepted 6 December 2006