Patient Preference for Patient-Delivered Partner Therapy: Exploratory Findings From Three Sexually Transmitted Disease Clinics

Abstract

To the Editor: Chlamydia trachomatis (CT) is the most common sexually transmitted bacterial infection reported in the United States.1 Most recurrent CT infections in women in the first few months after treatment are due to reinfection by an untreated male partner.2 The Centers for Disease Control and Prevention (CDC) recommend that all persons with a diagnosis of CT infection be candidates for partner services. Patient-delivered partner therapy (PDPT), where patients are given medication to deliver to each sex partner, is an important strategy for partner services when resources are limited.3 PDPT has been shown to reduce the risk for reinfection with CT.4,5 This study aimed to describe the partner treatment preference of patients visiting urban sexually transmitted disease (STD) clinics. Men and women who visited STD clinics in 3 US cities—New Orleans, LA; Jackson, MS; and St. Louis, MO—between June and September 2008 were invited to complete a short survey before being seen at the clinic. The survey was piloted at each study clinic before its implementation. The study was approved by institution review boards at each institution and the CDC and was exempt from informed consent. A total of 2887 individuals completed the survey. Over 90% of participants were blacks, 49.7% were female, and the mean age was 27.1 year (men: 28.4, women: 25.9). Participants were asked a single question about how they would like to get their partner(s) treated if they were diagnosed with CT. About half of all respondents (49.4%) preferred to send their partner to the clinic to be treated (Fig. 1). Women were significantly more likely than men to prefer treatment for their partners in the clinic (54.7% vs. 44.0%, P < 0.001). Only 20% (15.5% of males and 23.5% of females) preferred to “bring the medicine home for my partner(s) to take.” Among 407 patients who tested positive for CT, only 17.0% (n = 69) preferred PDPT.Figure 1.: Patient preference for treating partner(s) of patients with a Chlamydia infection, by sex (n = 2693) and age (n = 2677). PDPT indicates patient delivered partner therapy.Most participants in this study did not prefer PDPT. This was particularly true for younger study participants in whom the majority of CT infections is seen. A recent effectiveness study at a municipal STD clinic found that only 43% of patients accepted PDPT, in agreement with our findings, and that the risk of reinfection did not differ in patients who did and did not opt for PDPT.6 Other studies have concluded that PDPT is a successful strategy for the treatment of partners of men and women with STDs4,5,7 and the majority of patients were willing to participate in PDPT within the context of prospective studies.8,9 However, as pointed out recently by McBride et al.,10 STD clinic clients frequently are unfamiliar with the terms associated with STD treatment and may not always understand the definition of sexual partner. After addressing these issues, they found that acceptance of PDPT was high. Similarly, our results indicate that the concept of PDPT is not intuitive to STD clients. PDPT programs will not be successful in the absence of patient education concerning this approach to partner treatment and the risks of reinfection. Elizabeth J. Howard, MSPH Section of Infectious Diseases, School of Medicine Louisiana State University Health Sciences Center New Orleans, LA Fujie Xu, MD, PhD Division of STD Prevention Centers for Disease Control and Prevention Atlanta, GA Stephanie N. Taylor, MD Section of Infectious Diseases, School of Medicine Louisiana State University Health Sciences Center New Orleans, LA Bradley P. Stoner, MD, PhD Departments of Anthropology and Internal Medicine Washington University St. Louis, MO Leandro Mena, MD, MPH University of Mississippi Medical Center, Crossroads Clinics Mississippi State Department of Health Jackson, MS M. Jacques Nsuami, MD, MPH Section of Infectious Diseases, School of Medicine Louisiana State University Health Sciences Center New Orleans, LA Suzanne Powell, MPH Division of STD Prevention Centers for Disease Control and Prevention Atlanta, GA Rebecca Lillis, MD David H. Martin, MD Section of Infectious Diseases, School of Medicine Louisiana State University Health Sciences Center New Orleans, LA