Measuring the effectiveness of contact tracing

Effectiveness of self-referral for male patients with urethral discharge attending a sexually transmitted disease clinic in China

BACKGROUND

Although partner notification (PN) has long been considered as an important component in sexually transmitted disease (STD) control programs and has been implemented in both developed and developing world, little information is known about the acceptability and efficacy of the strategy in China.

GOAL

The goal of this study was to assess the acceptability and outcome of self-referral for male patients with urethral discharge and to identify the characteristics associated with successful outcome based on a specialized STD clinic.

METHODS

From November 2001 to November 2002, 730 patients with confirmed urethral discharge were selected and asked by STD clinicians to bring their sexual contacts to treatment in a specialized STD clinic. The demographic and sexual characteristics of returned and unreturned index patients were analyzed. Univariate and multivariate analyses were applied to identify the characteristics associated with the outcome of self-referral.

RESULTS

Of 723 eligible index patients, 294 (40.7%) who returned for follow up identified 534 sexual partners and 429 (59.3%) who did not return for follow up identified 759 sexual partners. Of the total named 1293 sexual partners, 301 (23.3%) were notified by index male patients and 265 (20.5%) presented at the clinic. Of the 265 partners tested, 165 (62.3%) were infected with gonorrhea, chlamydia, or both; of them, 78 (47.3%) were asymptomatic. When the partnerships were married and steady, the informed rate was higher than that when the partnership was casual. For commercial sexual partnerships, only 1.8% of the partners were informed. In multivariate analysis, a prior STD history and condom use during the last sexual contact were associated with successful outcome of notification.

CONCLUSION

Patient referral was accepted both by STD clinic attendees and STD clinicians. The results of the study show that use of self-referral for partners of men with urethral discharge in a Chinese STD clinic was, with minimal effort, moderately successful. Further efforts to improve case-finding outcomes are warranted.

The transformation of partner notification

Since 1996, several traditional epidemiological studies of program efficacy have done little to alter the fixed opinions of promoters or detractors of partner notification. Modeling studies have appeared that confirm the value of the contact-tracing approach in locating and treating persons who may be important in transmission. These provide a theoretical base for a number of empirical studies that have applied social network methods to classical partner-notification approaches, which have demonstrated the dense networks and geographic clustering of persons involved in sexually transmitted disease transmission and have provided justification for focusing efforts on small groups that may be critical to epidemicity or its maintenance. These initial studies would appear to warrant a broad-based inclusion of network concepts into programmatic activities, with careful monitoring and analysis of the impact they have on both the traditional indices of partner notification as well as the larger effect on disease transmission.

Success and failure in gonorrhea control

This article has shown that all the necessary components for successful control of gonorrhea are available. In developed countries, general improvements in economic conditions and advances in treatment and diagnosis have resulted in the lowest incidence rates of gonorrhea ever. Within these countries, however, control is failing, and gonorrhea is becoming hyperendemic among specific populations who tend to be disadvantaged and marginalized and who may have limited access to health care. Managing gonorrhea in individual patients and ensuring that their sexual partners receive appropriate treatment will contribute to reducing the transmission of infection in the community. Innovative school- and community-based interventions targeted to vulnerable populations will further help to reduce the incidence and contribute to improvements in the sexual health of the population.