Should partners of gonorrhea positive patients be treated with antibiotics or just tested for infection?

Management of Partners of Gonorrhea-Positive Patients

Partners of gonorrhea-positive patients should be treated empirically rather than just tested, as this approach prevents reinfection and curtails further transmission of the infection. 1

Partner Management Algorithm

1. Identify partners requiring treatment:

   • Sexual partners from the past 60 days before symptom onset or diagnosis 1, 2
   • If last sexual contact was >60 days ago, treat the most recent partner 1

2. Treatment approach:

   • Partners should receive the same treatment regimen as the index case
   • Treatment should include coverage for both gonorrhea and chlamydia (due to high co-infection rates) 1, 2

3. Partner notification options:

   • Patient referral: Index patient notifies partners to seek evaluation and treatment
   • Provider referral: Healthcare providers notify partners (when resources allow)
   • Patient-delivered partner therapy (PDPT): For heterosexual partners when partner treatment cannot be ensured 1

Rationale for Empiric Treatment

• Prevents reinfection of the index patient, which is common after treatment 1, 2
• Interrupts the chain of transmission in the community
• Addresses potentially asymptomatic infections in partners
• Prevents complications such as pelvic inflammatory disease (PID) in female partners 1

Special Considerations

• MSM partners: PDPT is not recommended due to high risk of coexisting undiagnosed STIs or HIV infection 1
• Pregnant partners: Should receive recommended cephalosporin treatment; quinolones and tetracyclines are contraindicated 1, 3
• Partners with allergies: Those who cannot tolerate cephalosporins should receive alternative regimens based on allergy profile 1

Important Caveats

• Partners should be instructed to abstain from sexual activity until both they and the index patient have completed treatment and are asymptomatic 1
• Partners should be screened for other STIs including syphilis and HIV 1
• Failure to treat partners is a common cause of persistent or recurrent infection 2
• Even if partners are treated, patients should be advised to return for retesting in 3 months due to high reinfection rates 1, 2

Partner-Delivered Therapy Considerations

When using patient-delivered partner therapy for heterosexual partners:

• Provide educational materials about gonorrhea and its treatment
• Include treatment for chlamydia
• Emphasize the importance of seeking clinical evaluation, especially for symptomatic female partners (due to PID risk) 1
• Ensure partners understand potential adverse reactions and when to seek medical care

By treating partners empirically rather than just testing them, the risk of reinfection is minimized, complications are prevented, and further transmission in the community is reduced.