UCL Discovery

Abstract

Objective: To examine the effectiveness of methods toimprove partner notification by patient referral (indexpatient has responsibility for informing sex partners oftheir exposure to a sexually transmitted infection).Design: Systematic review of randomised trials of anyintervention to supplement simple patient referral.Data sources: Seven electronic databases searched(January 1990 to December 2005) without languagerestriction, and reference lists of retrieved articles.Review methods: Selection of trials, data extraction, andquality assessment were done by two independentreviewers. The primary outcome was a reduction ofincidence or prevalence of sexually transmittedinfections in index patients. If this was not reported datawere extracted according to a hierarchy of secondaryoutcomes: number of partners treated; number ofpartners tested or testing positive; and number ofpartners notified, located, or elicited. Random effectsmeta-analysis was carried out when appropriate.Results: 14 trials were included with 12 389 women andmen diagnosed as having gonorrhoea, chlamydia, nongonococcalurethritis, trichomoniasis, or a sexuallytransmitted infection syndrome. All studies hadmethodological weaknesses that could have biasedtheir results. Three strategies were used. Six trialsexamined patient delivered partner therapy. Metaanalysisof five of these showed a reduced risk ofpersistent or recurrent infection in patients withchlamydia or gonorrhoea (summary risk ratio 0.73, 95%confidence interval 0.57 to 0.93). Supplementingpatient referral with information for partners was aseffective as patient delivered partner therapy. Neitherstrategy was effective in women with trichomoniasis.Two trials found that providing index patients withchlamydia with sampling kits for their partnersincreased the number of partners who got treated.Conclusions: Involving index patients in sharedresponsibility for the management of sexual partnersimproves outcomes. Health professionals shouldconsider the following strategies for the management ofindividual patients: patient delivered partner therapy,home sampling for partners, and providing additionalinformation for partners. Objective: To examine the effectiveness of methods toimprove partner notification by patient referral (indexpatient has responsibility for informing sex partners oftheir exposure to a sexually transmitted infection).Design: Systematic review of randomised trials of anyintervention to supplement simple patient referral.Data sources: Seven electronic databases searched(January 1990 to December 2005) without languagerestriction, and reference lists of retrieved articles.Review methods: Selection of trials, data extraction, andquality assessment were done by two independentreviewers. The primary outcome was a reduction ofincidence or prevalence of sexually transmittedinfections in index patients. If this was not reported datawere extracted according to a hierarchy of secondaryoutcomes: number of partners treated; number ofpartners tested or testing positive; and number ofpartners notified, located, or elicited. Random effectsmeta-analysis was carried out when appropriate.Results: 14 trials were included with 12 389 women andmen diagnosed as having gonorrhoea, chlamydia, nongonococcalurethritis, trichomoniasis, or a sexuallytransmitted infection syndrome. All studies hadmethodological weaknesses that could have biasedtheir results. Three strategies were used. Six trialsexamined patient delivered partner therapy. Metaanalysisof five of these showed a reduced risk ofpersistent or recurrent infection in patients withchlamydia or gonorrhoea (summary risk ratio 0.73, 95%confidence interval 0.57 to 0.93). Supplementingpatient referral with information for partners was aseffective as patient delivered partner therapy. Neitherstrategy was effective in women with trichomoniasis.Two trials found that providing index patients withchlamydia with sampling kits for their partnersincreased the number of partners who got treated.Conclusions: Involving index patients in sharedresponsibility for the management of sexual partnersimproves outcomes. Health professionals shouldconsider the following strategies for the management ofindividual patients: patient delivered partner therapy,home sampling for partners, and providing additionalinformation for partners.