For the curable, bacterial STIs, it is traditionally recommended that patients' partners be personally examined, counselled and treated. When practical, the partner should be managed by the health care provider or clinic that treats the index case.
Unfortunately, structural, geographical or other factors may make it difficult for follow-up of the partner to be undertaken by the same health care provider. In such cases, the partner should be referred to a specific health care provider or clinic known to be competent in STI management and sensitive to sexual health issues; it is probable that non-specific advice to the patient (e.g. "make sure your partner gets checked") often goes unheeded.
Public health agencies have a responsibility to ensure that clinical services are available to partners who cannot be treated by the index case's provider, by providing care at public clinics or facilitating referral to alternate sources of care.
One strategy that is effective in reducing the prevalence of infections within a community is empirical treatment. This is where the contact of a proven case of gonorrhoea, chlamydia, trichomoniasis or non-specific urethritis (NSU) is treated on the day they are interviewed and investigated, rather than waiting until the results are back. Treatment should be offered regardless of whether the contact is symptomatic or not, even if the contact declines testing.
The rationale for this treatment is:
- these diseases are highly infectious so there is a high probability that the contacts are infected
- the contact interview may be the only opportunity there is for treatment due to the high mobility of the patient group
- the sooner treatment is initiated the less likely transmission is to occur
- the treatment is simple (one dose) and has an acceptable side effect profile.
If GeneXpert point-of-care test is available, contacts can be treated on the basis of their point-of-care test result, i.e. if the contact of a proven case of gonorrhoea, chlamydia, trichomoniasis or non-specific urethritis (NSU) tests negative to the STI that his/her partner had, then treatment is not required.
As syphilis is less infectious and the treatment more difficult, ideally serology results should be reviewed before treatment is commenced for asymptomatic contacts of syphilis. However persons who were sexually exposed to a patient with primary, secondary, or early latent syphilis should be treated presumptively if serological test results are not available immediately and the opportunity for follow-up serology to cover the window period is uncertain. If in doubt, err on the side of offering the contact empiric treatment, (e.g. Benzathine penicillin 1.8 g intramuscularly as a single dose) especially if there is potential for onward transmission if the contact is infected.
A sample letter for your patient's contact to pass on to their own GP is provided. The letter explains:
- that they have been in contact with a person diagnosed with an STI
- that they might have also contracted an STI
- the importance and need for examination and testing, and that empirical treatment should be given for readily treatable bacterial STIs.