Divergent approaches to partner notification for sexually transmitted infections across the European union

OBJECTIVE: The objective of this study was to characterize partner notification (PN) policy and practice for sexually transmitted infections (STIs) in the European Union (EU) and Norway. GOAL: The goal of this study was to promote European good practice in PN. STUDY: This study consisted of a cross-sectional survey using a structured questionnaire to national STI surveillance leads. RESULTS: Considerable heterogeneity exists in approaches to PN. In 2 countries, PN is compulsory for notifiable STIs; and in 13, it is voluntary. Most countries use patient referral but 5 of 15 also offer provider referral. Activity level varies by country and disease. Etiologic treatment of contacts is most common; 5 usually offer epidemiologic treatment and patient-expedited treatment is unusual. Similarities exist with provision mainly by specialized STI treatment services for bacterial STIs. CONCLUSIONS: This divergence in approach calls for the setting of minimum standards for PN delivery together with mechanisms for establishing and sharing best practice. Further research must identify monitoring systems for inclusion in routine surveillance.     

Laboratory investigation: sexually transmitted diseases

Sexually transmitted diseases are among the most common infectious diseases and pose a major public health concern globally. Unfortunately, such diseases are often asymptomatic, and are left untreated for long periods of time—resulting in significant health care costs and morbidity rates. In recent years, the advancement in diagnostic testing has been tremendous, especially at the molecular level of disease. In the paper to follow, we will attempt to examine diagnostic techniques traditionally used (microscopic examination and culture) to identify STDs and compare them to newly introduced techniques (including DNA amplification and hybridization) that provide higher sensitivity and specificity, as well as shorter result reporting time.     

HIV seropositivity among patients with sexually transmitted diseases

2013 patients with various sexually transmitted diseases were screened for HIV antibodies in voluntary counseling and testing centre (VCTC) attached to Microbiology Lab of Govt. Medical College, Amritsar from Jan. 1998 to Dec. 2001. Sixty-one (3.03%) were found to be positive for HIV. 44 were males and 17 were females. There was a constant rise in the percentage positivity in females from 14.3% in 1998 to 38.09% in 2002. There was also rise in the prevalence of HIV among the STD attenders (1.65% in 1998 to 5.13% in 2001).     

Factors influencing sexual partner referral for sexually transmitted diseases in Uganda.

BACKGROUND AND OBJECTIVE: Patient-based partner referral has limited effectiveness. We studied factors associated with sexual partner referral among patients with sexually transmitted diseases (STDs) with a view of suggesting remedial action. GOAL: To examine the role of psychosocial variables vis-a-vis other variables in predicting sexual partner referral. STUDY DESIGN: A cross-sectional interview survey with 507 patients with STDs at an STD clinic in Kampala, Uganda. Multivariate analyses were used to identify independent predictors of sexual partner referral. RESULTS: Forty-two percent of the 599 partners elicited were referred. The independent factors that favored sexual partner referral were examined in the laboratory (adjusted odds ratio [AOR] 2.20, 95% confidence interval [CI] 1.20-4.05): psychosocial variables of intention (likelihood of referring the partner) (AOR 4.60, CI 1.58-13.36), self-efficacy (partner referral being easy) (AOR 3.22, CI 1.36-7.66), having a positive attitude toward partner referral (AOR 1.19, CI 1.06-1.33), and previous success in having referred a partner (AOR 9.78, CI 2.90-33.04). Other variables, such as age, sex, marital status, employment, and type of partner, that were significant on univariate analysis were not significant after multivariate analysis. CONCLUSION: By providing interventions to change the psychosocial variables, there is a high chance of improving compliance with sexual partner referral.     

Selected sexually transmitted diseases and their relationship to HIV

Although sexually transmitted diseases (STDs) are underreported and underrecognized, they are a major source of morbidity, mortality, and represent a major socioeconomic cost in developing and industrialized nations. Individuals who develop STDs are often coinfected with human immunodeficiency virus (HIV). Coinfection with HIV both facilitates the natural history of STDs and worsens the clinical picture. The objective of this article is to provide a review to the practicing clinician on the epidemiology, clinical manifestations, methods of diagnosis, and treatment for four cutaneous STDs—chancroid, genital herpes, granuloma inguinale, and lymphogranuloma venereum—in coinfected HIV patients.     

Risks of acquiring and transmitting sexually transmitted diseases in sexual partner networks

BACKGROUND: A person's risk for acquiring infection and their role in continued transmission has traditionally been assessed on the basis of individual characteristics. Recently, network studies have attempted to relate individual risks to position in the wider network. GOAL: To assess the importance of local and global network structures in assessing the risk of acquiring and transmitting infection. STUDY DESIGN: An individual-based simulation model was used to construct a variety of potential network structures and track the transmission of infection over time. Logistic and Poisson regression were used to identify which measures of network position influence a person's risk for acquiring and transmitting infection. RESULTS: Measures of local centrality were more important to risk of acquisition, whereas global centrality mattered more to transmission. Continuous snowball sampling, rather than a fixed number of waves, better estimates a person's risks. CONCLUSIONS: There is an asymmetry regarding the risk of acquiring and transmitting infection.     

Patient-delivered partner treatment and other partner management strategies for sexually transmitted diseases used by New York City healthcare providers

OBJECTIVES: The objectives of this study were to measure frequency and predictors of patient-delivered partner treatment (PDPT) and the frequency of other partner management strategies among New York City healthcare providers (HCPs) as well as to determine whether use of PDPT detracts from other partner management strategies. STUDY DESIGN: The authors conducted a cross-sectional survey of New York City HCPs. RESULTS: Frequent patient referral was reported by 93.6% (368 of 393) of healthcare providers; only 20% (80 of 401) reported frequent use of provider referral. Overall, 49.2% (196 of 398) of HCPs reported ever using PDPT and 27.1% (108 of 398) reported using PDPT frequently. HCP specialty, practice setting, duration of practice, report of frequent provider referral practice, and HCP race/ethnicity were the strongest predictors of PDPT use. HCPs reporting PDPT use were more likely to report frequent provider referral than those who had never used PDPT (26.7% vs. 12.6%; P <0.001). CONCLUSIONS: PDPT use is common and is being used in conjunction with other partner management strategies.     

HBsAg and sexually transmitted diseases

HBsAg was studied in 50 patients of STD's and promiscuous persons. In 10.52% cases it was positive. Vaccination against Hepatitis-B was recommended in promiscuous individuals.     

Patient-delivered partner therapy for sexually transmitted diseases as practiced by U.S. physicians

OBJECTIVE: The objective of this study was to estimate how many U.S. physicians practice patient-delivered partner therapy (PDPT), which is the practice of giving patients diagnosed with curable sexually transmitted infections medication to give to their sex partners. STUDY: The authors conducted a national survey of physicians in specialties that diagnose the majority of sexually transmitted diseases in the United States. RESULTS: A total of 3011 physicians diagnosed at least 1 case of either gonorrhea or chlamydial infection in the preceding year. For gonorrhea and chlamydial infection, 50% to 56% reported ever using PDPT; 11% to 14% reported usually or always doing so. Obstetricians and gynecologists and family practice physicians more often used PDPT than internists, pediatricians, and emergency department physicians. Clinicians who collected sex partner information, as well as those who saw more female and white patients, used PDPT most often. CONCLUSIONS: PDPT is widely but inconsistently used throughout the United States and is typically provided to a minority of persons.     

Evaluation of a video based health education strategy to improve sexually transmitted disease partner notification in South Africa

OBJECTIVES: To evaluate the feasibility and impact of a health education intervention promoting partner notification for sexually transmitted diseases (STDs). METHODS: The research setting was a busy public health clinic in a rural district in KwaZulu Natal, South Africa. A before/after quantitative study design was used to measure the effect of an audiovisual presentation of a compelling love drama, posters, and pamphlets. Measures collected from all consenting STD index patients during a 6 week pre-intervention (control) phase were compared with those collected during a 6 week intervention phase. A qualitative evaluation assessed whether the intervention accurately portrayed the intended educational messages. RESULTS: 150 index patients (55% female) were interviewed in the control phase and 185 index patients (64% female) in the intervention phase. The intervention phase showed improvements on several measures of self efficacy about notifying casual partners, such as a belief among index patients that a greater proportion of their casual partners would see the importance of seeking treatment as a result of their notification interaction. The rate of contact cards returned per index patient was 0.27 in the intervention phase, compared with 0.20 in the control phase (95% CI for the rate difference: -0.05, 0.17). The qualitative research found that the intervention was thoroughly enjoyed by patients and clinicians, but a fundamental problem with it was that patients received confused messages about the relation between HIV/AIDS and other STDs. This has potentially negative consequences for partner notification. CONCLUSION: The intervention needs further development, and then could provide a highly acceptable, cost effective model for health education in clinics in developing countries.     

Needs assessment for STD/HIV prevention among patients with sexually transmitted diseases in southern China

BACKGROUND AND GOAL: Patients with sexually transmitted diseases (STDs) serve as a bridge population to transmit HIV from higher-risk to lower-risk populations. Our goal was to understand the level of risk behaviors and HIV/STD-related knowledge as well as attitudes among STD patients in China. STUDY DESIGN: An anonymous questionnaire was self-administered by 619 STD patients in Guangzhou, China. RESULTS: About 70% of the males and 18% of the females had had sex with nonregular sex partners in the previous 6 months; the prevalence of consistent condom use was very low (20% for males and 10% for females). Only 20% to 30% of the respondents stated that they would not practice unprotected sex with nonregular sex partners before their STD was cured. Misconceptions about STD/HIV are very common. STD/HIV-related knowledge, perceived susceptibility of contracting HIV, and perceived efficacy of condom use for HIV/AIDS prevention were significantly associated with anticipated or actual risk behaviors during the infectious period. CONCLUSION: Intervention programs are in urgent need to break the cycle of STD infection in China. These would include promotion of relevant knowledge, condom use, and public education.