Parker GreggVanderbilt School of Medicine

Class of 2012

STI Rate Per 100,000

Chlamydia 559.33

Gonorrhea 175.58

Primary and Secondary Syphilis 8.36

Total 247.76

*Data from the CDC website

Elicits at-risk sexual partners and offer them testing and treatment

Prevents transmission to other partners Prevents re-infection of the index patient

Widely used in Europe in the mid-19th century

Initiated in the US in 1930s for syphilis

Major change in partner notification Emphasis on civil rights of people with

HIV/AIDS HIV exceptionalism

Patient-based Provider-based Conditional referral

Type of PN systemFeasibility Acceptabilit

yEffectiveness

Patient-based √√√ √√√ √√

Provider-based √ √ √√√

Conditional referral

√ √√ √√√

Curable vs. incurable STIs Social consequences Discrimination Domestic Violence PN in the setting of syndromic management

◦ Neither sensitive nor specific◦ Overuse of antibiotics

Confidentiality vs. partners’ rights

Provider-based systems try to address this◦ Voluntary participation of index patients◦ Providers don’t reveal index patient identity

Partners’ right to know their exposures Controlled by state law for HIV

◦ Duty to notify◦ Privilege to notify◦ Provider-based PN illegal

Patient-delivered partner medication(PDPM)

Requires single-dose treatments Requires continuously available PDPM Give antibiotics to people not seen in clinic Fails to address co-infections Under-treatment of target infection Lack of partner consent Decrease partners’ access to follow-up care

Asymptomatic partners may not take PDPM Implications of seriousness of STIs Index patients may not deliver PDPM Debate about which partners get PDPM

◦ No partners◦ Regular only/spouse only◦ All partners

PN decreases the incidence of STIs There is no one best system

◦ Context matters!◦ Acceptability, feasibility, and effectiveness within

a specific population Challenges to PN are significant but can be

addressed

Questions?Contact me at lucile.p.gregg@vanderbilt.edu

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