Physicians' opinions on partner management for nonviral sexually transmitted infections

BACKGROUND: Patient-delivered therapy (PDT) for nonviral sexually transmitted infections (STIs) is the practice of dispensing or prescribing medication to patients for their sex partners. While this practice is effective in preventing re-infection in patients, its use is not widespread. The purpose of this survey was to assess physicians' PDT practices and opinions toward potential benefits and perceived barriers associated with PDT. METHODS: During 2003 and 2004, a random sample of family and general practitioners, internists, emergency medicine physicians, and obstetricians/gynecologists in Connecticut and Rhode Island were mailed surveys and responses were analyzed. RESULTS: A response rate of 53% was obtained. Approximately 50% of 111 respondents reported having ever used PDT, although a much smaller proportion (6%) reported using it frequently. Potential benefits cited by many physicians included preventing the spread of STI (83%), reinforcing need for partner treatment (78%), and prevention of re-infection in the patient (63%). However, many perceived barriers were also noted, including difficulty ensuring delivery of medication to the partner (96%), concern about adverse reactions in partners (88%), liability (75%), and missed opportunities for other clinical services (68%). Half of all respondents said that they would support legislation to authorize PDT. CONCLUSIONS: The use of PDT is not widespread; physicians recognize the benefits of PDT but many concerns were also noted. A growing body of research indicates that several perceived barriers may be largely unsubstantiated. Therefore, dispelling physician concerns and defining the legal environment surrounding PDT might encourage physicians to use PDT when it is clinically indicated, thereby preventing re-infection in patients and further spread in the community.