Treatment Of Sexual Partners Research Articles

Expedited Treatment of Sex Partners

Expedited Treatment of Sex Partners

Effect of expedited treatment of sex partners on recurrent or persistent gonorrhea or chlamydial infection

Effect of expedited treatment of sex partners on recurrent or persistent gonorrhea or chlamydial infection

The Prevalence of Chlamydia, Gonorrhea, and Trichomonas in Sexual Partnerships: Implications for Partner Notification and Treatment

Treatment of sex partners by patient-delivered partner therapy (PDPT) may prove to be an effective strategy in reducing reinfection and preventing the sequelae of sexually transmitted infections (STIs). However, limited data exists regarding STIs within sexual partnerships (dyads). The objective of this study was to determine the prevalence of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (GC), and Trichomonas vaginalis (TV) in sexual dyads to estimate the potential yield and limitations of PDPT. Male and female STI clinic attendees were invited to participate. Index subjects and partners were interviewed and tested for CT, GC, and TV. All partners were sought regardless of infection status of the index subject. Of 210 dyads, the prevalence in index subjects was CT, 46%; GC, 18%; and TV, 14%. Considering the partners of 72 CT-only-infected index subjects, 57% had CT, 6% had GC, and 11% had TV. Considering the partners of 35 index subjects with GC or GC-CT coinfection, 57% had GC and/or CT; however, in 20% of partners, unsuspected TV was present. Among 74 dyads with uninfected index subjects, 26% of partners had an STI. Among the partners of 19 index subjects with TV only, 11% had CT, 5% had GC, and 37% had TV. In our clinic population, a substantial number of partners had infections different from or in addition to those infections in the index. Many of these infected partners would not be diagnosed and treated using PDPT. Partners of index attendees without detected infection were at high risk (26%) for STI, mostly CT.

Effect of Expedited Treatment of Sex Partners on Recurrent or Persistent Gonorrhea or Chlamydial Infection

Many sex partners of persons with gonorrhea or chlamydial infections are not treated, which leads to frequent reinfections and further transmission. We randomly assigned women and heterosexual men with gonorrhea or chlamydial infection to have their partners receive expedited treatment or standard referral. Patients in the expedited-treatment group were offered medication to give to their sex partners, or if they preferred, study staff members contacted partners and provided them with medication without a clinical examination. Patients assigned to standard partner referral were advised to refer their partners for treatment and were offered assistance notifying partners. The primary outcome was persistent or recurrent gonorrhea or chlamydial infection in patients 3 to 19 weeks after treatment. Persistent or recurrent gonorrhea or chlamydial infection occurred in 121 of 931 patients (13 percent) assigned to standard partner referral and 92 of 929 (10 percent) assigned to expedited treatment of sexual partners (relative risk, 0.76; 95 percent confidence interval, 0.59 to 0.98). Expedited treatment was more effective than standard referral of partners in reducing persistent or recurrent infection among patients with gonorrhea (3 percent vs. 11 percent, P=0.01) than in those with chlamydial infection (11 percent vs. 13 percent, P=0.17) (P=0.05 for the comparison of treatment effects) and remained independently associated with a reduced risk of persistent or recurrent infection after adjustment for other predictors of infection at follow-up (relative risk, 0.75; 95 percent confidence interval, 0.57 to 0.97). Patients assigned to expedited treatment of sexual partners were significantly more likely than those assigned to standard referral of partners to report that all of their partners were treated and significantly less likely to report having sex with an untreated partner. Expedited treatment of sex partners reduces the rates of persistent or recurrent gonorrhea or chlamydial infection.

Managing Syphilis in the HIV-infected Patient.

Syphilis has re-emerged in the United States and elsewhere, and clinicians caring for HIV-infected patients are challenged with syphilis diagnosis and management decisions. HIV alters the natural history of syphilis to an extent that is poorly understood, and initial presentation may be more varied in coinfected patients. Although commonly available diagnostic assays for syphilis should be interpreted as usual, such tests rely on antibody measurement and may be an imperfect indicator of active infection. Assessment of all available clinical and risk behavior data remains critically important in the diagnosis of syphilis in coinfected patients. Treatment of syphilis in such patients requires stage-appropriate therapy, with careful serologic monitoring to assess response. Clinicians must have heightened appreciation of the role of frequent risk assessment, serologic screening, symptom recognition, and follow-up of treated patients, as well as an understanding of public health functions such as sex partner treatment and communicable disease reporting.

Partner management for gonococcal and chlamydial infection: expansion of public health services to the private sector and expedited sex partner treatment through a partnership with commercial pharmacies.

Public health partner notification (PN) services currently affect only a small minority of patients with gonorrhea or chlamydial infection and new approaches to PN are needed. To expand PN for gonorrhea and chlamydial infection to private sector patients and to assess the feasibility of treating sex partners through commercial pharmacies. Selected patients were offered PN assistance and were randomly offered medication to deliver to their partners. Providers permitted the health department to contact 3613 (91%) of 3972 potentially eligible patients, and 1693 (67%) of 2531 successfully contacted patients consented to interview. Of these, 1095 (65%) reported at least one untreated partner. Most patients (90%) wished to notify partners themselves. Patients were more likely to have partners who had not yet been treated and to request PN assistance if they had more than one sex partner in the preceding 60 days or a partner they did not anticipate having sex with in the future. These two factors characterized 49% of all patients interviewed, 70% of those with a partner that was untreated 7 or more days after index patient treatment, and 83% of those accepting PN assistance. Among 458 randomly selected patients with untreated partners at time of study interview, 346 (76%) agreed to deliver treatment to a partner. Of these, most (266) chose to obtain medication for a partner at a pharmacy, of whom 223 (84%) successfully did so. A substantial minority of private sector patients have untreated partners more than 7 days after their own treatment; some need help with PN, but most will agree to deliver medication to partners themselves.

Bacterial vaginosis and treatment of sexual partners.

Bacterial vaginosis and treatment of sexual partners.

Sexual contact tracing outcome in adolescent chlamydial and gonococcal cervicitis cases

Treatment of sex partners is an essential part of sexually transmitted diseases (STD) control. This study examined the efficacy of contact tracing via patient self-referral in gonococcal and chlamydial cervicitis cases among adolescents, compared with the effectiveness of provider-referral. Adolescent females with culture-proven chlamydial or gonococcal cervicitis were the study subjects. This cohort study was done in an urban non-STD clinic setting. The subjects chose either provider-notification or self-notification method to inform their sex partner(s) in 2 months preceding the interview date. Two hundred and sixty-five eligible subjects (91% African-American, 9% white) were identified. One hundred and ninety-eight sex contacts were reported by 165 (62%) cases; no contact was elicited in the remaining 100 (38%). The follow-up data revealed that 129/198 (66%) contacts were informed: 63 contacts by 61 index cases, 54 contacts of 47 cases by the case manager, 9 by both methods, and 3 by unspecified means. History of treatment was obtained in 54 contacts, including 37% (23/63) of patient-notified contacts and 50% (27/54) of provider-notified contacts; these 54 contacts constituted 42% of informed contacts, or 27% of all named contacts. The mean number of sexual contacts treated per index case was 0.58 (27/47) for the provider-referral groups and 0.38 (23/61) for the self-referral groups. Successful contact tracing was documented in 19.3% (51/265) of all index cases, resulting in treatment of 54 contacts. This study demonstrates the need for more effective partner treatment strategies in adolescent STD cases.

Evolving Strategies for Management of the Nongonococcal Urethritis Syndrome

Nongonococcal urethritis (NGU) is the most common sexually transmitted disease (STD) syndrome that occurs in men and accounts for an estimated 4 million to 6 million physician visits annually.1As with other sexually transmitted infections, the clinical management of patients with NGU ideally should include accurate identification of the most likely causative agent; prompt administration of effective antimicrobial therapy to alleviate symptoms, eradicate the causative organism, and prevent secondary complications; and initiation of appropriate counseling and intervention for notification and treatment of sexual partners. Unfortunately, in caring for patients with NGU, these components of clinical management are not straightforward. Clinicians have difficulty identifying patients with NGU because many are asymptomatic and not all of the organisms that cause NGU are known. In addition, current therapies are not ideal, and appropriate counseling and partner notification are made difficult by uncertainties in each of these areas. Fortunately, the investigation by Stamm

Cervical cancer screening of women attending sexually transmitted disease clinics.

Prevention programs at clinics for sexually transmitted diseases (STDs) have traditionally focused on reducing the spread of STDs through prompt diagnosis and treatment of infections and through notification and treatment of sex partners. For women the clinic examination also offers an opportunity to prevent cervical cancer, a sequela of STDs. Women who have had STDs are at increased risk for cervical cancer, and women who seek health care at public clinics frequently have additional characteristics that place them at risk for not having had a recent Papanicolaou (Pap) smear. Despite the opportunity for cervical cancer screening that is afforded by a visit to an STD clinic, in most public clinics a Pap smear is not part of the routine examination of women. This report summarizes the evidence supporting cervical cancer screening for women with STDs (particularly women attending STD clinics) and addresses the advantages, disadvantages, and net yield of previous screening programs at STD clinics.

Effective treatment of urethritis. A practical guide.

Most cases of urethritis can be readily treated using recommended regimens. The most important causes of urethritis are Chlamydia trachomatis and Neisseria gonorrhoeae, and initial treatment is directed at them. Optimal management requires obtaining a thorough sexual history, evaluation for objective clinical and laboratory evidence of infection, antimicrobial therapy directed towards the major aetiologies, and evaluation and treatment of sexual partners. Treatment of gonorrhoea requires a single-dose regimen active against N. gonorrhoeae, plus a regimen active against C. trachomatis and nongonococcal urethritis. The usually recommended treatment for N. gonorrhoeae is a single dose of ceftriaxone 250mg intramuscularly, but there are many alternatives, including oral ones. Only in very restricted geographical areas and under restricted situations are penicillins still reliable against N. gonorrhoeae. Recommended optimal treatment of C. trachomatis or nongonococcal urethritis currently requires 7 days' treatment with a tetracycline. Some guidelines now propose ofloxacin 300 mg orally twice daily for 7 days as an equivalent alternative, and there are very promising data with a single dose therapy with azithromycin, a long-acting macrolide antimicrobial. Using recommended regimens, microbiological failure is infrequent in compliant patients. Recurrent urethritis is, however, frequent. For patients who receive recommended treatment and do well, no follow-up cultures are needed. Patients with persistent or recurrent symptoms require careful re-evaluation of the patient, documentation of urethritis, and retreatment with antimicrobial agents a second time if urethritis is documented by positive cultures or increased numbers of polymorphonuclear leucocytes in urethral secretions.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnosis and Therapy for Common Sexually Transmitted Diseases

During the past decade, as the human immunodeficiency virus (HIV) has appeared, sexually transmitted diseases (STDs) have resurged to epidemic proportions, and STDs have been shown to facilitate transmission of HIV, the diagnosis and treatment of STDs have increased in importance for all clinicians. This article's recommendations for treatment of STDs that might more commonly be seen in a dermatology practice are based on the 1989 Sexually Transmitted Disease Treatment Guidelines of the Centers for Disease Control. Clinicians are encouraged to address actively prevention and treatment of sexual partners, a very important part of the management of STDs.

Approach to Men with Urethritis and Urologic Complications of Sexually Transmitted Diseas

The most important causes of urethritis, and epididymitis in younger men, are C. trachomatis and N. gonorrhoeae. Management of these syndromes requires a thorough sexual history, genital examination, evaluation for objective and laboratory evidence of infection, antimicrobial therapy directed toward the major etiologies, and evaluation and treatment of sexual partners. Treatment of N. gonorrhoeae requires use of a single-dose regimen active against this organism, plus a 7- to 10-day tetracycline regime active against C. trachomatis and nongonococcal urethritis. With recommended regimens, microbiologic failure is infrequent in compliant patients. Recurrent urethritis is frequent, however. The management of patients with persistent or recurrent symptoms requires careful reevaluation of the patient, documentation of urethritis, and re-treatment with antimicrobials if urethritis is documented by positive cultures or increased numbers of polymorphonuclear leukocytes in urethral secretions. Additional treatment beyond this point usually is not indicated, even though a proportion of men will remain symptomatic and some of these will have increased numbers of polymorphonuclear leukocytes in urethral secretions. The most important causes of prostatitis, and epididymitis in older men or men with urethral structural abnormalities, are classical urinary tract pathogens rather than sexually transmitted pathogens. Management of these infections includes documentation of the infection and treatment directed toward the specific pathogen. Men with symptoms of "prostatitis" must be evaluated using both urine and prostatic secretions to document infection and inflammation. The majority of men with such symptoms do not have an infection that can be documented. These men respond poorly to medications. Men with documented chronic bacterial prostatitis require long courses of antimicrobials to effect cure. In some cases, however, the disease is intractable, and chronic suppression with antimicrobials may be necessary.

Chlamydial infections. Gaining control of a growing epidemic.

Infections caused by Chlamydia trachomatis are wide-spread, costly, and damaging. Consequences are harshest for women because of the adverse effects on the reproductive system. Newborns of infected mothers may also be affected. Screening of sexually active patients is important, because many infected patients are asymptomatic. Newer, improved laboratory techniques are available. Treatment with doxycycline, tetracycline, or erythromycin is preferred. Simultaneous treatment of sexual partners is vital.

The Predictive Power and Cost of Screening for Chlamydia-Reply

In Reply.— We appreciate the comments of Dr Rice and Dr Rieger. Dr Rice's question deals with the difference between sensitivity and positive predictive value. Sensitivity is the probability of a positive test in patients known to have disease. Positive predictive value is the probability of disease in patients with a positive test. The two are related by Bayes' theorem, which states that positive predictive value = (sensitivity × prevalence)/(probability of a positive test). Using the sensitivity (53%), specificity (96%), and prevalence (7.94%) values given in our article, one can calculate the probability of a positive test (7.9%) and the positive predictive value for the direct antigen test (53%). That the positive predictive value and the sensitivity are numerically identical is perhaps confusing, but the figures in the article are correct. We certainly advocate treatment for sexual partners of infected women and made this point in our article. Dr Rieger wishes

Genito‐urinary approach to the management of colposcopic abnormalities of the cervix

SummaryOne hundred and fifty nine patients with abnormal cervical cytology were studied by colposcopy and histologically. Fifty six were attending the Department of Genito‐Urinary Medicine, 103 were referred from elsewhere. The STD clinic patients were younger (73 per cent under the age of 29 years) and 89 per cent had a satisfactory colposcopy. The incidence of cervical intra‐epithelial neoplasia (C1N) for both groups was 87 per cent. This was associated with human papilloma virus in 35 per cent of cases. Treatment by laser vaporisation for CIN with koilocytic change was 100 per cent successful, probably due to the screening and treatment of sexual partners. A distinct genitourinary approach to these patients is suggested. Patients with an unsatisfactory colposcopy (with evidence of CIN) should be referred to the gynaecologist for cone biopsy and treatment without any further investigations such as colposcopic cervical biopsies in the STD clinic. Patients with a satisfactory colposcopy may be investigated, treated and followed‐up in the STD clinic.

Gonorrhea.

The gonococcus has become an extremely important organism in obstetrics and gynecology. It is associated with a wide array of clinical syndromes that frequently confront the practitioner. The diagnostic modalities available are many and are rapidly increasing. Therapy likewise is becoming complex as we learn more about the infections associated with this microbe. The basic principles of care still include a high index of suspicion of infection; clinical evaluation of the potentially infected patients; laboratory support of the clinical diagnosis; specifically directed antimicrobial therapy of adequate dosage and duration; treatment of sexual partners; and follow-up test-of-cure evaluation in all patients.

Gonorrhea

Diagnosis and Treatment1 May 1979GonorrheaCenter for Disease Control Recommended Treatment Schedules, 1979Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-90-5-809 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail AbstractAbstractThese recommendations specify appropriate treatment, including dosage of antibiotics for uncomplicated gonococcal infections in adults, infections with penicillinase-producing Neisseria gonorrhoeae, acute salpingitis, acute epididymitis, disseminated gonococcal infections, and gonococcal infections in pediatric patients (including neonatal infections). Special attention is given to important diagnostic considerations, relation of gonococcal infections to concomitant venereal infections, treatment of sexual partners, follow-up, treatment failures, treatments not recommended, allergic problems in treatment, needs for hospitalization, and prevention of gonococcal ophthalmia. Attention is called to the importance of using no less than the recommended dosages of antibiotics. This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: ▸From the U.S. Department of Health, Education, and Welfare, Public Health Service, Center for Disease Control; Atlanta, Georgia. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byGonorrheal Infection, Pelvic Inflammatory Disease and Spinal DisabilityGonorrhea and the Story of Resistant Neisseria gonorrhoeaeNew Antibiotics.PENICILLINASE-PRODUCING GONOCOCCI: FURTHER COMPLICATIONSTOXICOLOGY OF MEDICAL DEVICESPenicillin-Resistant Gonococcal Arthritis A Report of Four CasesRENEE Z. RINALDI, M.D., WILLIAM O. HARRISON, M.D., PENG THIM FAN, M.D.AmoxicillinAmoxil® (Beecham)Larotid® (Roche) 1 May 1979Volume 90, Issue 5Page: 809-811KeywordsAntibioticsGonorrheaHospitalizationsMedical servicesNeisseria gonorrhoeaePediatric infections ePublished: 1 December 2008 Issue Published: 1 May 1979 PDF downloadLoading ...