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Successes and Controversies of Partner Notification for Sexually Transmitted Infections

Successes and Controversies of Partner Notification for Sexually Transmitted Infections. Parker Gregg Vanderbilt School of Medicine Class of 2012. Tennessee STI Data, 2008. *Data from the CDC website. Benefits of Partner Notification.

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Successes and Controversies of Partner Notification for Sexually Transmitted Infections

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  1. Successes and Controversies of Partner Notification for Sexually Transmitted Infections Parker Gregg Vanderbilt School of Medicine Class of 2012

  2. Tennessee STI Data, 2008 *Data from the CDC website

  3. Benefits of Partner Notification Elicits at-risk sexual partners and offer them testing and treatment Prevents transmission to other partners Prevents re-infection of the index patient

  4. History of Partner Notification • Widely used in Europe in the mid-19th century • Initiated in the US in 1930s for syphilis

  5. Dr. Kampmeier and the Medical L Clinic at Vanderbilt

  6. PN for HIV/AIDS • Major change in partner notification • Emphasis on civil rights of people with HIV/AIDS • HIV exceptionalism

  7. Types of PN Systems • Patient-based • Provider-based • Conditional referral

  8. Controversies of PN • Curable vs. incurable STIs • Social consequences • Discrimination • Domestic Violence • PN in the setting of syndromic management • Neither sensitive nor specific • Overuse of antibiotics • Confidentiality vs. partners’ rights

  9. Confidentiality vs. Partners’ Rights • Provider-based systems try to address this • Voluntary participation of index patients • Providers don’t reveal index patient identity • Partners’ right to know their exposures • Controlled by state law for HIV • Duty to notify • Privilege to notify • Provider-based PN illegal

  10. Patient-delivered partner medication (PDPM)

  11. Controversies of PDPM • Requires single-dose treatments • Requires continuously available PDPM • Give antibiotics to people not seen in clinic • Fails to address co-infections • Under-treatment of target infection • Lack of partner consent • Decrease partners’ access to follow-up care

  12. Controversies of PDPM • Asymptomatic partners may not take PDPM • Implications of seriousness of STIs • Index patients may not deliver PDPM • Debate about which partners get PDPM • No partners • Regular only/spouse only • All partners

  13. Conclusions • PN decreases the incidence of STIs • There is no one best system • Context matters! • Acceptability, feasibility, and effectiveness within a specific population • Challenges to PN are significant but can be addressed

  14. Questions? Contact me at lucile.p.gregg@vanderbilt.edu

  15. Sources • Apoola A, Radcliffe KW, Das S, Robshaw V, Gilleran G, Kumari BS, Boothby M, Rajakumar R. Patient Preferences for Partner Notification. Sex Transm Inf 2006; 82: 327-329 • Coyne KM, Cohen CE, Smith NA, Mandalia S, and Barton S. Patient-delivered partner medication in the UK: an unlawful but popular choice. Int J STD AIDS 2007; 18: 829-831 • Golden M, Whittington W, Hendefield H, et al. Effect of expedited treatment of sex partners on recurrent or persistent gonorrhea or chlamydial infection. N Engl J Med 2005; 352: 676-85 • Gostin LO, Hodge JG. Piercing the Veil of Secrecy in HIV/AIDS and Other Sexually Transmitted Diseases: Theories of Privacy and Disclosure in Parnter Notification. Duke J of Gender Law and Policy 1998; 5:9. • Markos A. Patient-delivered partner medication: the antagonism of clinical standards and good medical practice. Int J STD AIDS 2008; 19: 283-284 • Mayaud P, Mabey D. Approaches to the control of sexually transmitted infections in developing countries: old problems and modern challenges. Sex Tramsm Infect 2004; 80: 174-182 • Moi H. Care of Sexually Transmitted Infections in Nordic Countries. Int J STD AIDS 2001; 12: 819-823 • Nuwaha F, Kambugu F, Nsubuga PS, Hojet B, Faxelid E. Efficacy of patient-delivered partner medication in the treatment of sexual partners in Uganda. Sex Transm Dis 2001; 28: 105-10 • Potterat JJ. Parnter referral tools and techniques for the clinician diagnosing a sexually transmitted infection. Int J STD AIDS 2007; 18: 293-296 • Young T, de Kock A, Jones H, Altini L, Ferguson T, and van de Wijgert J. A comparison of two methods of partner notification for sexually transmitted infections in South Africa: patient-delivered partner medication and patient-based partner referral. Int J STD AIDS 2007; 18: 338-340

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