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STIs in sex partners notified for chlamydia exposure: implications for expedited partner therapy
  1. Fleur van Aar1,
  2. Birgit H B van Benthem1,
  3. Ingrid V F van den Broek1,
  4. Hannelore M Götz1,2
  1. 1 Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
  2. 2 Department of Infectious Disease Control, Municipal Public Health Service, Rotterdam, the Netherlands
  1. Correspondence to Fleur van Aar, National Institute for Public Health and the Environment, PO Box 1, 3720BA, Bilthoven, the Netherlands; fleur.van.aar{at}rivm.nl

Abstract

Objectives Expedited partner therapy (EPT) may reduce chlamydia reinfection rates. However, the disadvantages of EPT for chlamydia include missing the opportunity to test for other STIs and unnecessary use of antibiotics among non-infected partners. As part of a larger study that investigated the feasibility of EPT in the Netherlands, we explored the frequency of STI among a potential EPT target population of chlamydia-notified heterosexual men and women attending STI clinics for testing.

Methods Cross-sectional national STI/HIV surveillance data, which contain information on all consultations at STI clinics, were used to calculate STI positivity rates stratified by chlamydia notification and gender, and proportions of STI that were attributable to clients notified for chlamydia.

Results Of all consultations in 2015 (n=101 710), 14 445 (14.4%) clients reported to be notified exclusively for chlamydia. Among chlamydia-notified clients, the chlamydia positivity rate was 34.2% (n=4947), and consequently 65.8% (n=9488) of them tested negative for chlamydia. Chlamydia-notified clients contributed to 10.2% of all gonorrhoea infections (n=174/1702) and 10.9% of all infectious syphilis, HIV and/or infectious hepatitis B infections (n=15/173).

Conclusion Implementing EPT without additional STI testing for all partners of chlamydia-infected index patients implies that STIs other than chlamydia will be missed. Although the chlamydia positivity rate was high among chlamydia-notified partners, two-thirds would unnecessarily use azithromycin. An evaluation of EPT against the current partner treatment strategy is needed to carefully weigh the potential health gains against the potential health losses and to explore the characteristics of EPT-eligible partners.

  • chlamydia trachomatis
  • partner notification
  • gonorrhoea
  • infection control
  • surveillance

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Footnotes

  • Handling editor Katy M E Turner

  • Contributors FA coordinated the national STI clinic data collection, analysed and interpreted the data, and drafted the manuscript. HMG was the leader of the PICC-UP project. All other authors were involved in the data interpretation and contributed to drafting and revision of the paper. All authors read and approved the final manuscript.

  • Funding This work was part of a larger project ‘Patient Initiated Contact treatment for Chlamydia: Understanding the Potential for increased effectiveness of Partner treatment in the Netherlands’ (PICC-UP), which was supported by the Netherlands Organisation for Health Research and Development (ZonMw) (grant number: 522002001).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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