Effect of Expedited Treatment of Sex Partners on Recurrent or Persistent Gonorrhea or Chlamydial Infection
Matthew R. Golden, M.D., M.P.H., William L.H. Whittington, A.B., H. Hunter Handsfield, M.D., James P. Hughes, Ph.D., Walter E. Stamm, M.D., Matthew Hogben, Ph.D., Agnes Clark, B.S., Cheryl Malinski, B.S., Jennifer R.L. Helmers, B.S., Katherine K. Thomas, M.S., and King K. Holmes, M.D., Ph.D.
Background Many sex partners of persons with gonorrhea or chlamydialinfections are not treated, which leads to frequent reinfectionsand further transmission.
Methods We randomly assigned women and heterosexual men withgonorrhea or chlamydial infection to have their partners receiveexpedited treatment or standard referral. Patients in the expedited-treatmentgroup were offered medication to give to their sex partners,or if they preferred, study staff members contacted partnersand provided them with medication without a clinical examination.Patients assigned to standard partner referral were advisedto refer their partners for treatment and were offered assistancenotifying partners. The primary outcome was persistent or recurrentgonorrhea or chlamydial infection in patients 3 to 19 weeksafter treatment.
Results Persistent or recurrent gonorrhea or chlamydial infectionoccurred in 121 of 931 patients (13 percent) assigned to standardpartner referral and 92 of 929 (10 percent) assigned to expeditedtreatment of sexual partners (relative risk, 0.76; 95 percentconfidence interval, 0.59 to 0.98). Expedited treatment wasmore effective than standard referral of partners in reducingpersistent or recurrent infection among patients with gonorrhea(3 percent vs. 11 percent, P=0.01) than in those with chlamydialinfection (11 percent vs. 13 percent, P=0.17) (P=0.05 for thecomparison of treatment effects) and remained independentlyassociated with a reduced risk of persistent or recurrent infectionafter adjustment for other predictors of infection at follow-up(relative risk, 0.75; 95 percent confidence interval, 0.57 to0.97). Patients assigned to expedited treatment of sexual partnerswere significantly more likely than those assigned to standardreferral of partners to report that all of their partners weretreated and significantly less likely to report having sex withan untreated partner.
Conclusions Expedited treatment of sex partners reduces therates of persistent or recurrent gonorrhea or chlamydial infection.
Source Information
From the Division of Infectious Diseases and the Center for AIDS and Sexually Transmitted Diseases (M.R.G., W.L.H.W., H.H.H., J.P.H., W.E.S., K.K.T., K.K.H.) and the Department of Biostatistics (J.P.H.), University of Washington, Seattle; Public Health–Seattle and King County, Seattle (M.R.G., H.H.H., A.C., C.M., J.R.L.H.); and the Division of Sexually Transmitted Diseases Prevention, Center for Human Immunodeficiency Virus, Sexually Transmitted Diseases, and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta (M.H.).
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