Should you test or treat partners of patients with gonorrhea, chlamydia, or trichomoniasis?
GENERALLY SPEAKING, TREATING PARTNERS EMPIRICALLY IS AS EFFECTIVE or more effective than traditional referral and testing. Empiric treatment of partners of female or heterosexual male patients diagnosed with gonorrhea or chlamydia using expedited partner therapy (having the index patient deliver therapy to the partner) decreases the risk of persistent or recurrent infection in the index patient (strength of recommendation [SOR]: A, meta-analysis). The effect is greater for gonorrhea than chlamydia.
By contrast, expedited partner therapy for trichomoniasis appears equivalent to a test-first approach (SOR: B, single randomized controlled trial [RCT]).
No studies have evaluated empiric treatment of chlamydia, gonorrhea, or trichomoniasis in men who have sex with men. State laws vary with regard to expedited partner therapy and should be considered. Moreover, this type of empiric therapy misses the opportunity to counsel partners and treat comorbid disease, if present.
Evidence summary
Treating partners of patients with sexually transmitted infection has been a core component of therapy since the 1940s. Traditionally, partners have been referred to a health care provider (by the index patient, the provider, or a public health officer) for evaluation before being treated. Current methods of partner referral reach only 40% to 60% of named sexual partners.1
Expedited partner therapy vs traditional patient referral
Success of treatment is most readily measured by a reduction in the persistence or recurrence of infection in the index patient. Four RCTs and 1 observational cohort study have compared traditional patient referral with expedited partner treatment.2-6 The primary outcome measure in all studies was reduction of persistent or recurrent infection in the index patient ( TABLE 1 ).
Chlamydia. Of the 4 studies that evaluated expedited partner treatment for chlamydia, 1 cohort study showed a statistically significant decrease in recurrent or persistent chlamydial infection in index patients.2 One RCT showed a statistically significant reduction in recurrent or persistent urethritis, but didn’t report persistent and recurrent gonorrheal and chlamydial infections separately.3 Two RCTs showed a decrease in recurrent or persistent chlamydial infection in the index patient, but the difference didn’t reach statistical significance.4,5
Gonorrhea. Two RCTs evaluated expedited partner treatment for gonorrhea compared with patient referral. One demonstrated a statistically significant decrease in persistent or recurrent gonococcal infection.5 The other showed a statistically significant decrease in recurrent or persistent urethritis, but without identifying recurrent gonorrheal and chlamydial infections separately.3
Trichomoniasis. One RCT compared expedited partner therapy with patient referral for patients with trichomoniasis. The study didn’t show a statistically significant difference in recurrent or persistent infection.
TABLE 1
Traditional patient referral vs expedited partner treatment: How the 2 compare
| Patient population | Design | Outcomes | Favored treatment: PDPT vs PR | P value | NNT |
|---|---|---|---|---|---|
| Heterosexual men with N gonorrhoeae or C trachomatis2 | RCT | Recurrent/persistent N gonorrhoeae or C trachomatis | PDPT | <.001 | 5 |
| Women with C trachomatis3 | RCT | Recurrent/persistent C trachomatis | PDPT | .11 | 33.3 |
| Women and heterosexual men with N gonorrhoeae or C trachomatis4 | RCT | Recurrent/persistent N gonorrhoeae | PDPT | .01 | 12.5 |
| Recurrent/persistent C trachomatis | PDPT | .17 | 50 | ||
| Women with T vaginalis5 | RCT | Recurrent/persistent T vaginalis | PR | .64 | 32.3 |
| Women with C trachomatis6 | Observational cohort | Recurrent/persistent C trachomatis | PDPT | <.05 | 7.1 |
| C trachomatis, Chlamydia trachomatis; N gonorrhoeae, Neisseria gonorrhoeae; NNT, number needed to treat; PDPT, patient delivered partner therapy; PR, patient referral; RCT, randomized controlled trial; T vaginalis, Trichomonas vaginalis. | |||||
