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Partner notification in primary care
  1. J A Cassell1,
  2. M G Brook1,
  3. R Slack2,
  4. N James2,
  5. A Hayward2,
  6. A M Johnson3
  1. 1Department of Sexually Transmitted Diseases, Royal Free and University College Medical School, Mortimer Market Centre, Off Capper Street, London WC1E 6AU, UK
  2. 2Division of Public Health Sciences, University of Nottingham Medical School
  3. 3Centre for Infectious Disease Epidemiology, Department of Primary Care and Population Sciences and Department of Sexually Transmitted Diseases, University College London, London, UK
  1. Correspondence to:
 Dr Jackie Cassell, Department of Sexually Transmitted Diseases, Royal Free and University College Medical School, Mortimer Market Centre, Off Capper Street, London WC1E 6AU, UK; 
 jackiec{at}quadrivium.demon.co.uk

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In the past decade chlamydia tests have become more widely available in primary care, and many female patients are now diagnosed and treated in this setting.1,2 The lack of skills and resources for partner notification in primary care is now a matter of public health concern.3 We undertook a survey of GPs in three districts in order to explore their current practice and attitudes in relation to partner notification and treatment.

All GPs in the Nottingham Health District (n=367), and GPs recruited for the Chlamydia Partnership Project in north London (n=65) (a randomised trial of health adviser led partner notification for primary care patients) were invited to complete a short questionnaire. The response rate was 56%.

Of the 242 respondents, 86% considered testing for genital Chlamydia trachomatis infection in women to be a GP role, while 60.7% considered that partner notification is not a role of the GP; 90.5% of respondents thought that one or more patients had had a positive test at the practice in the preceding year.

Among GPs who had recently been involved in managing chlamydia, 82.5% always or sometimes managed the patient wholly within primary care; 70.1% said they “always” or “sometimes” managed partners. However, responsibility for ensuring this happened was generally devolved to the patient, since 73.8% “always,” and 22.5% “sometimes” dealt with partner notification by telling the patient to get the partner treated.

GPs appeared to be well aware of the importance of contact tracing. Respondents were asked to state difficulties in managing chlamydia in free text form. Of 200 GPs stating one or more difficulties, 76.5% mentioned contact tracing. Other problems commonly cited were follow up or compliance (21.5%), explanation, supporting relationships and counselling (17.5% of respondents), perceived inadequacies of tests, mainly poor sensitivity and invasiveness (12.5%), and the diagnosis of coexisting infections (10.5%).

The majority of GPs (69.9%) would treat with an appropriate antibiotic of equal or greater dose and duration than that currently recommended by the Central Audit Group for Genitourinary Medicine, while 17.3% specified an inadequate course. Dosage or duration could not be ascertained in 12.7% of responses. This suggests substantial improvement in the past few years,4 although our study probably over-represents GPs already testing for chlamydia and may exaggerate the extent of good practice.

Our study suggests that GPs already willingly take on an important role in diagnosing and managing genital chlamydia infection. They agree overwhelmingly that partner notification is the main difficulty in managing these patients. However, there is little evidence of follow up strategies designed to minimise re-infection risk, as in previous studies.5,6 and the majority of GPs consider that partner notification is not their role. The latter view probably explains why the majority manage partner notification by simply telling the patient to deal with it, without support or follow up.

If testing in primary care continues to increase without adequate support for partner notification, much of the resource used in testing women will be wasted. The announcement of pilot sites for chlamydia testing in primary care is to be welcomed.3 However, support for GPs in partner notification should not wait for the roll out of a national programme, since many patients diagnosed in primary care are already at risk of re-infection and onward transmission.

Acknowledgments

We are grateful to NoCTeN and Trent Focus (primary care research networks) for facilitating the Chlamydia Partnership Project. Dr Jackie Cassell was supported on a Health Services Research Training Fellowship by the Wellcome Trust.

References

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