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Abstract
Background Partnership characteristics, for example, their length, timing, and whether or not condoms are used, may be more important for assessing STI transmission risk than partnership numbers. However, data routinely collected by GUM clinics in the UK are limited in terms of such measures of partnership risk. We sought to measure this in a high-risk population and consider the implications for STI transmission and partner notification (PN).
Methods Cross-sectional survey of 2203 people attending 4 sociodemographically and geographically contrasting GUM clinics in England in 2009. Attendees completed a questionnaire that was linked to their clinical records for data on acute STI diagnoses. Questions asked about their three most recent partnerships in the 3 months prior to attending GUM and the total number of partners in this period. We used a novel statistical approach to weight the data to represent the partnerships for which these questions were not asked. This enables us to describe the population of partnerships reported by GUM attendees, rather than the population of attendees.
Results Most patients had few partners: median: 1 partner, IQRs: 1–3 (men) and 1–2 (women). However, the 1941 attendees reporting partners reported a total of 3576 partners: 1953 by 846 men, 1623 by 1095 women. Men's partnerships were shorter than women's: 73% vs 54% (p<0.01) were <3 months “old” (49% vs 27%, respectively, were one-off encounters), and were more likely to be considered as ended: 64% vs 41%, respectively, p<0.01, see Abstract P2-S4.02 figure 1 Inconsistent condom use was high, especially in women's partnerships: 81% vs 65% among men's partnerships, p=0.002. Men (but not women) were more likely to have acute STIs diagnosed if they had never used condoms with their partners than if they had at least once: 33% vs 27%, p=0.001. 24% of men vs 14% of women had recent concurrent partnerships based on the dates of their 3 most recent partners (p<0.01), but this was not associated with having acute STI diagnoses.
Distribution of partnership length by partnership status and gender of GUM clinic attendee.
Conclusions Despite low median partner numbers, GUM attendees have a large population of partnerships, of which only a small minority involve consistent condom use, thus the potential for STI transmission is high. These partnerships are often casual in nature being short in duration and unlikely to be ongoing. Research is needed to develop and test alternative methods for reaching such partners to ensure that PN achieves both individual and public health benefit.