Your patient has an STI: How do you tell her partner?

July 1, 2007

Expedited Partner Therapy (EPT) can be a powerful tool for reducing STI ireinfection. But do you dare treat her partner sight unseen in this litigious climate?

Ob/gyns can implement in their offices referral of patients with STIs-with or without expedited partner therapy-to help prevent recurrent STIs and improve patients' sexual health.

When a woman presents with a sexually transmitted infection (STI), naturally your first steps involve diagnosis and treatment. But your next steps ought to include something about partner management, for a woman whose partner or partners remain untreated is quite likely to become infected again.

Partner notification in a nutshell

This means that, compared with syphilis (a few thousand incident cases a year), the process occurs less frequently for gonorrhea (a few hundred thousand) and less frequently yet for chlamydial infections (a few million). The statistics reflect the fact that public health programs typically lack the resources to trace partners of people diagnosed with chlamydial or gonococcal infections: estimates of their successful partner interviewing rates for these STIs are 12% to 17%, compared to 89% for syphilis.9

Thus, it often falls to the health-care provider to deal with notifying the partner. However, few obstetrician and gynecologist offices can routinely offer partner notification services, so they have to pass the job on to their patients. While most clinicians will offer basic instructions to a patient to inform her partner(s) herself (this is known as patient referral),3 few offices are keen on collecting information about the patients' partner, contacting partners, and so forth.10 (Providers tend to feel it interferes with patient relationships and doesn't work any better than patient referral.11 ) Some retrospective studies suggest that 30% to 60% of patients actually do inform their partners, and women are probably better at this task than are men.12 Nevertheless, patient referral without some sort of enhancement isn't very effective. Enhancements could go a long way to ensuring that the partners notified actually get evaluated and treated.

Enhancing partner management in your office

Our purpose here is to describe enhancements that ob/gyns can implement in their offices. Although we discuss pro-vider referral and using referral cards to improve patient referral, we devote the most space to a more recently evaluated enhancement to patient referral: giving medications or prescriptions to patients to deliver to their partners before those partners receive a medical evaluation: Expedited Partner Therapy (EPT).

PROVIDER REFERRAL

That so many providers are ill-equipped or ill-disposed toward provider referral doesn't mean every provider has to leave it alone. As an ob/gyn, you would have to interview the infected patient for her partners' names, identifying information, and location; attempt to contact those partners; and assure their evaluation. When the patient has only one partner, the process can be fairly straightforward, although it still tends to take up the morning's visit (and surely to collect the information confers some responsibility to follow-up-demanding more time).