Background Partner notification (PN) is a core component of the management of sexually transmitted infections (STI). A range of methods can help to find, test and treat sexual partners of an infected person (index patient). The objective of this review was to assess the effects of different PN strategies in people with STI, including HIV infection.
Methods We conducted this review for the Cochrane STI Review Group. We searched for randomised controlled trials (RCTs) in Cochrane, MEDLINE and EMBASE databases, reference lists and trial registries up to 18 October 2018. Two independent reviewers conducted screening, selection and data extraction. Primary biological outcomes were: repeated infection in index cases with curable STI and new infections in partners of people with HIV. We conducted meta-analysis where appropriate.
Results We included 37 trials from 14 countries in Asia, Australia, Europe, South America, sub-Saharan Africa and USA in patients with bacterial STIs or trichomonas (n=26 trials), STI syndromes (n=5), HIV (n=5), mixed STI (n=1). The 37 trials assessed 56 comparisons between PN strategies, with the most common being enhanced patient referral (n=22) and expedited partner therapy (EPT, n=18) for curable STI and contract referral for HIV (n=3). For index cases with chlamydia, gonorrhoea or trichomonas as a combined outcome, EPT reduced repeat infection compared with simple patient referral (n=6,390, relative risk 0.71, 95% confidence interval, CI 0.59–0.86, I-squared 0%) but not compared with enhanced patient referral (n=1,220, relative risk 0.96, 95% CI 0.6–1.53, I-squared 33%). For HIV, contract referral, versus simple patient referral, increased the number of partners found infected (n=1,884, mean difference 0.15, 95% CI 0.06–0.24, I-squared 0%).
Conclusion EPT is better than simple patient referral, but not better than enhanced patient referral for curable STI. Many PN strategies have limited evidence. Future trials should strengthen evidence of effectiveness by evaluating existing PN strategies using biological outcomes.
Disclosure No significant relationships.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.