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Partner notification for sexually transmitted infections in the modern world: a practitioner perspective on challenges and opportunities
  1. Gill Bell1,
  2. John Potterat2
  1. 1Genitourinary Medicine, Royal Hallamshire Hospital, Sheffield, UK
  2. 2Independent Consultant, Colorado Springs, Colorado, USA
  1. Correspondence to Gill Bell, Nurse Consultant Sexual Health Adviser, Department of Genitourinary Medicine, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK; gill.bell{at}sth.nhs.uk

https://doi.org/10.1136/sextrans-2011-050229

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    Introduction

    Our aim is to provide a practitioner perspective on approaches to partner notification (PN)—some old, some new—which may improve the control of sexually transmitted infections (STIs), including HIV, in a variety of settings.

    PN services support patients with STI/HIV in the difficult task of informing often unsuspecting partners—past or present—of their possible exposure to an STI and hence the need to seek medical care. It is an essential component of STI management and control, protecting patients from reinfection, partners from long-term tissue damage from untreated infection and the community from onward transmission. Beneficial dimensions include ethics (duty to warn), disease control (case finding) and epidemiology (identifying factors associated with STI transmission).1

    PN methods

    Patients may inform partners themselves (patient referral) or supply details for a healthcare worker to notify the partner without disclosing their identity (provider referral). These approaches may be combined whereby a time frame is agreed for patients to inform partners before the healthcare worker notifies those who have not sought care (contract referral).

    Patient referral is the method used most frequently, partly because most patients prefer to notify their own partners and also because provider referral is not available in some settings.2 3 The stigma attached to STIs/HIV can, however, make informing partners traumatic: Gorbach et al4 found that up to one third of patients failed to tell all partners because of embarrassment or fears for personal safety or reputation. Least likely to be informed are casual and ex-partners4 5 who may have moved on to infect new partners. Provider referral is therefore an important service to protect patients from adverse consequences and reach partners who would not otherwise be informed, thereby improving disease intervention.

    Variations in practice

    The intensity of …

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