Background Partner services are crucial for syphilis control. The Sexual Health Centre (SHC) in Rotterdam introduced an algorithm to guide decisions for presumptive partner treatment (PPT) for syphilis. It aimed to identify partners at greatest risk for infectious syphilis and further transmission, who should be treated presumptively (without awaiting laboratory confirmation). Those deemed less likely to be infected were offered testing, and treatment or follow-up consultation as appropriate.
Methods To assess the performance of the PPT algorithm, we reviewed all notified partners of men who have sex with men (MSM) diagnosed with syphilis in the SHC from 1 February to 31 December 2017. The algorithm is a 12-parameter binary decision tree with two possible outcomes: ‘presumptive treatment’ or ‘await lab results’. We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) to evaluate the algorithm against clinical outcomes.
Results Among all consultations, 12% (16/135) had syphilis. The algorithm indicated presumptive treatment in 74% (100/135) of consultations. Among those, 86% (86/100) tested negative, all of whom reported their last sexual contact within the previous eight weeks. Among partners where the algorithm indication was to wait, 6% (2/35) tested positive. The algorithm sensitivity and specificity were 88% (14/16), and 28% (33/119), respectively, with a PPV of 14% (14/100) and NPV of 94% (33/35). The algorithm indication was followed in 81% (110/135) of consultations); 83 clients were offered direct treatment, and 52 standard testing. Among 47 MSM with negative results at 1st consultation, 22 (47%) had no documented follow-up.
Conclusion While PPT can prevent further transmission, it may lead to overtreatment. This algorithm identified most MSM with infectious syphilis, and ‘overtreatment’ of some notified partners is warranted, given the large proportion who were within 8 weeks of last sexual contact. We recommend inclusion of this algorithm into routine sexual health practice.
Disclosure No significant relationships.
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