What is the most appropriate approach to partner notification for an individual diagnosed with a sexually transmitted infection (STI)?

Partner Notification for Sexually Transmitted Infections

Partner notification for sexually transmitted infections is confidential and voluntary, not mandatory, and depends on the cooperation of the patient to help break chains of transmission. 1

Partner Notification Approaches

The Centers for Disease Control and Prevention (CDC) emphasizes that partner notification is a critical component of STI control that must maintain the confidentiality of the index patient while aiming to break chains of transmission. There are two primary approaches:

1. Patient Referral

   • The index patient directly informs their sexual partners
   • Can be simple patient referral or enhanced patient referral (with additional support)
   • Most commonly used approach

2. Provider Referral

   • Healthcare professionals or health department staff notify partners
   • Often more effective than patient referral alone
   • Research shows provider referral can result in notification of 50% of partners compared to only 7% with patient referral 1

In the case of this 26-year-old man with gonococcal infection, he should be informed that partner notification is voluntary and confidential, and he has options for how to proceed.

Confidentiality and Voluntary Participation

Partner notification maintains several key principles:

• Confidentiality is paramount - The identity of the index patient is protected during the notification process 1
• Voluntary participation - The patient decides whether to participate in partner notification
• Support options - Patients can receive assistance from healthcare providers or health departments
• Education - Patients should be informed about the importance of notifying partners to prevent reinfection and community transmission

Notification Strategies and Options

For this patient with gonococcal infection, several notification strategies could be discussed:

• Enhanced patient referral - Providing the patient with communication strategies, educational materials, and support for notifying partners himself
• Expedited partner therapy - In some jurisdictions, this allows the patient to deliver medication or a prescription to partners without requiring a medical examination of the partner 2
• Provider referral - If the patient is concerned about direct notification, healthcare providers can notify partners while maintaining the patient's confidentiality

A randomized controlled trial showed that enhanced patient-based notification programs can help reduce risks for subsequent STIs among patients presenting at STI clinics, with participants more likely to report partner notification (92% vs. 86% in control group) 3.

Common Pitfalls and Considerations

• Assuming notification is mandatory - This is incorrect; partner notification is voluntary 1
• Breaching confidentiality - Healthcare providers must protect patient privacy during the notification process
• Neglecting to offer assistance - Many patients find partner notification more difficult than anticipated
• Not discussing electronic notification options - For partners met online, electronic communication (email, text messaging) may be appropriate, though acceptability varies 4, 5

Practical Approach for This Patient

1. Explain that partner notification is confidential and voluntary
2. Discuss the importance of notification to prevent reinfection and community transmission
3. Present both patient referral and provider referral options
4. Offer assistance with notification strategies if needed
5. Consider provider referral if the patient is concerned about direct notification
6. Document the discussion and the patient's decision

By following this approach, the healthcare provider can support this patient in making an informed decision about partner notification while respecting his autonomy and confidentiality.