Gonorrhoea in Coventry 1991-1994: epidemiology, coinfection and evaluation of partner notification in the STD clinic

Abstract

The aim of this study is to analyse the epidemiology of gonorrhoea in the Coventry area between 1991-1994 and the implementation and outcome of partner notification. A total of 404 episodes in 382 patients comprised the study group. In Coventry, 97% of episodes were managed in the STD clinic. There was a decrease in female and heterosexual male cases from 172 cases in 1991 to 37 cases in 1994 and increase in homosexual male cases from 8 in 1991 to 13 in 1994 (P<0.0001). Chlamydial coinfection was found in 38%. Among patients with gonorrhoea, 33% were asymptomatic and 40% with gonorrhoea and chlamydia were asymptomatic. Ten per cent of index cases were asymptomatic as were 83% of contact cases (P<0.0001). The health advisers (HAs) interviewed 82% immediately and 94% at some time after diagnosis. Of the average 1.5 partners per patient identified, 0.31 partners per patient were already screened, another 0.4 partners per patient were traced, 0.37 partners per patient were not traced, and for 0.41 partners per patient notification outcome was unknown or unconfirmed. Partner notification of 278 index cases traced 163 primary or tertiary contacts, 115 were new cases of gonorrhoea.

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

“…Research of traditional partner notification programs has demonstrated that a significant number of partners do not seek care in a timely manner. 4,33,34 We suggest that, when possible within STI clinic settings using PDPT, partners be screened for other infections regardless of the treatment received. Strategies that would enhance partner testing such as self-collected specimens (eg, urine or vaginal/urethral swabs) that could be mailed or dropped in at the STI clinic need to be examined.…”

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

“…However, partner notification assistance is infrequently provided by health departments in the United States to patients with gonorrhea or chlamydial infection, and when assistance is provided, the process has been relatively inefficient when extended to second-generation sexual contacts. 24,25 Beyond the potential deleterious effects of patient-delivered partner therapy, legal barriers and the uncertain availability of cefixime may inhibit its use. Although commonly used, 17 the legality of patient-delivered partner therapy remains ill-defined in most states, and more widespread use of it or other approaches to expedited treatment of partners may require new laws or administrative rulings.…”

Case-Finding Effectiveness of Partner Notification and Cluster Investigation for Sexually Transmitted Diseases/HIV

“…29,30 However, most reports indicate that provider referral, when implemented, accounts for a greater percentage of partners actually notified than patient referral 31 39,40 However, PN for syphilis in Louisiana between 1993 and 1996 showed essentially uniform yields across different age groups of index cases. 17 Cases' sex also had no relation to yield for STD or HIV PN: the brought-to-treatment index was higher for females in 6 of 12 studies that allowed such comparisons (appendix in online technical report).…”

“…39,[41][42][43][44][45][46] However, the lowest reported case-finding yields for syphilis and HIV PN occurred in samples of cases where MSM overwhelmingly predominate or in areas where the majority of diagnosed cases are in MSM 26 (also see appendix in online technical report). Interestingly, in the 1950s and 1960s, MSM in many US communities (e.g., Dallas, Los Angeles, and Richmond) cooperated extensively with contact investigations for syphilis and gonorrhea, resulting in successful PN, despite the illegality of homosexual behavior at the time in all of those areas.…”