The provision of chlamydia or gonorrhea treatment directly to patients' sexual partners, without requiring the partners to visit a physician, significantly improved infection control in patients, researchers at the University of Washington in Seattle reported.
“We believe that the inadequacies of current approaches to partner notification and the persistence of unacceptably high levels of morbidity from sexually transmitted infections in the United States should motivate both clinicians and public health authorities to incorporate patient-delivered partner therapy and other approaches to expedited care of partners into clinical and public health policies,” wrote Matthew R. Golden, M.D., the lead investigator (N. Engl. J. Med. 2005;352:676-85).
The study randomized 2,751 patients recently treated for chlamydia and/or gonorrhea infections to either expedited treatment or standard referral for their partners.
The 1,376 patients in the expedited treatment group were offered medication to give to as many as three partners. An additional 1,375 patients in the standard referral group were advised to tell their partners to seek care, available at no cost at the public health department's sexually transmitted diseases (STD) clinic.
The medication for partners in the expedited treatment group was distributed to patients at the STD clinic, by direct mail, or through participating pharmacies. It consisted of either a single 400-mg dose of cefixime and a 1-g sachet of azithromycin for partners of patients with gonorrhea or azithromycin only for partners of patients with chlamydia. Warnings and information about the medication, condoms, and STD prevention also were included in the packets.
A total of 1,860 patients completed the study and were interviewed and retested 10-18 weeks after their initial diagnosis and treatment.
More patients in the expedited treatment group reported that their partners were likely to have been treated, or to have tested negative for STDs—making persistent or recurrent infection with either gonorrhea or chlamydia significantly less common in this group (10%), compared with the standard referral group (13%), for a relative risk of 0.76.
Expedited treatment was more effective in reducing gonorrhea (73%) than chlamydia (15%)—a finding that might be partially explained by chlamydia treatment failure, the authors suggested.
The findings represent “a major advance for the control and prevention of STDs,” reported Emily J. Erbelding, M.D., and Jonathan M. Zenilman, M.D., of Johns Hopkins University, Baltimore, in an accompanying editorial (N. Engl. J. Med. 2005;352:720-1).
“We can conclude that the use of expedited approaches designed to circumvent traditional evaluation by a clinician increases the chance of an exposed partner's receiving proper therapy and, most important, reduces the original patient's risk of reinfection,” they wrote.
The study authors noted several weaknesses in their model of patient-delivered partner therapy, including legal barriers in many states, the uncertain availability of cefixime, and the potential adverse effects of treating partners without a clinical evaluation.