PARTNER NOTIFICATION

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PARTNER NOTIFICATION

• Pauline Rorie
• Health Adviser
• GUM NINEWELLS

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Objectives

• Identify what, why and how
• Aims of Partner Notification (PN)
• Key elements of PN interview
• Strategies for PN in Primary Care

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PARTNER NOTIFICATION

• the process of contacting the sexual partners
  of patients diagnosed with a sexually transmitted
  infection(STI) and advising them to attend for
  screening and treatment.

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PARTNER NOTIFICATION

• Essential in the management of Chlamydia
  infection to
• prevent reinfection of index patient
• prevent transmission to others
• prevent complications of infection in partners

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PARTNER NOTIFICATION

• Identify social networks of people practising
  risky sexual behaviour
• Decrease to pool of infectious people
• Prevent transmission of HIV

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INFECTIONS REQUIRING PARTNER NOTIFICATION

• BACTERIAL Chlamydia
• Gonorrhoea
• Syphilis
• Protozoal Trichomonas
• Vaginalis (TV)
• Viral HIV
• Hepatitis B C

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PARTNER NOTIFICATION INTERVIEW

• Nature of infection
• Sexual History
• Negotiation of PN

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NATURE OF INFECTION

• What the infection is/how it is transmitted
• Symptoms/lack of symptoms
• Complications of untreated infection
• Treatment and compliance
• Why no sexual intercourse?
• Health education on STI/HIV prevention

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PARTNER NOTIFICATION

• Sexual history identifies at-risk partners
• How you or me?
• PATIENT REFERRAL index patient agrees to notify
  partners themselves
• PROVIDER REFERRAL health adviser agrees to
  notify the indexs partner/s on their behalf
• CONDITIONAL REFERRAL index pt agrees to notify
  their partner/s within an time health adviser
  notifies partner/s if dont attend
• Letter/phone/text/face to face/e-mail

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POSITIVE RESULTS IN PRIMARY CARE

• Sexual history/nature of infection/TX
• Raise issue of PN
• Refer patient to Health Adviser/Community Sexual
  Health for PN follow up
• Different venues/GUM
• Care Pathways (Non-GUM settings)
• Helpful Contact telephone no for pt.
• - no of sexual contacts in 6/12

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Seeing Partners in Primary Care

• Sexual history
• Any risk of reinfection?
• Test and treat
• Raise issue of PN
• Treatment compliance
• Why no sexual intercourse?
• Refer if positive for PN follow up

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FOLLOW UP OF POSITVE RESULT BY HEALTH ADVISER

• Identify risk of reinfection
• Treatment failure
• To initiate PN process (e.g. GP referral)
• Opportunity to inquire about outcome of informing
  partners
• To encourage disclosure to partners who remain
  uniformed

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Case scenario - Michael
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Case scenario- Tom

• Named by 2 female patients who attended GUM - ve
  Chlamydia
• (1 routine STI screen/1 symptomatic)
• 3 letters sent
• Attended after 7 weeks
• ve Chlamydia
• 12 sexual partners

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PARTNER NOTIFICATION

• Key Points
• Many people diagnosed with an STI do not have
  symptoms and may not inform their past or current
  sexual partners
• Patient referral most commonly used preferred
  method by patients doctors
• Current methods of patient referral only reach
  40-60 of named sexual partners
• (Trelle et al 2007)

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PARTNER NOTIFICATION

• Key Points contd.
• Contacts are more likely to attend for assessment
  as a result of provider referral than by patient
  referral
• (Mathew Coetzee 2006)
• Assisting patients with STIs to get partners
  testedtreated is an essential element of patient
  care
• Raising the profile of this part of STI care
  could in itself improve outcomes of partner
  notification (NICE 2007)

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CONCLUSION

• Partner Notification is resource dependant, time
  consuming and not always easy
• A patient attended the clinic recently having
  been informed he was a contact of syphilis. He
  was tested and treated. Look back period
  identified approx. 100 partners if positive
• Help is at hand , refer on!