Patient referral outcome in gonorrhoea and chlamydial infections.

Abstract

Objective: To describe the outcome of patient referral at the STD clinic of the University Hospital Rotterdam. To study characteristics of heterosexual index patients and partnerships related to referral outcome. Methods: In 1994, patients with gonorrhoea and chlamydia were referred to public health nurses for interview and patient referral. Referral outcome was classified as "verified" if partners attended the STD clinic and as "believed" if partners were said to have attended elsewhere. Results: Of 454 patients, 250 (55%) participated in the study. The outcome of patient referral for the 502 eligible partners was 103 (20.5%) verified referrals, 102 (20%) believed referrals, and 297 (59%) with unknown follow up. Of the 103 partners examined, 43 had an STD of which 63% reported no symptoms. The contact finding ratio was higher for chlamydia patients and heterosexual men. Also, referral was more eVective for index patients with recent sexual contact, with follow up visits to the public health nurse, for men who were not commercial sex worker (CSW) clients, and, to a lesser degree, for Dutch patients and patients who sometimes used condoms. For steady partners, referral was improved if the last sexual contact was more recent. Casual partners visited the clinic more often if sexual contact occurred more than once, if the last contact was more recent, if they were older, and if they were Dutch. Conclusions: Patient referral was more eVective for certain groups, such as chlamydia patients and steady partners, but was inadequate for others, including CSW and their clients, other "one night stands", young partners, and ethnic minorities. (Sex Transm Inf 1998;74:323-330)

Effectiveness of Self-Referral for Male Patients With Urethral Discharge Attending a Sexually Transmitted Disease Clinic in China

“…Constraint as a result of stigma limited efforts to trace patients and partners. 20 Our study showed that 1.79 partners per index case were identified (range, 1-13), which was less than the number in one study 11 and more than the number in others. 9,11,21 Of 1293 partners identified, 301 (23.3%) partners were notified.…”

“…20 Our study showed that 1.79 partners per index case were identified (range, 1-13), which was less than the number in one study 11 and more than the number in others. 9,11,21 Of 1293 partners identified, 301 (23.3%) partners were notified. This could be underestimated, because some partners could have used a different name, could have visited different doctors when they attended our clinic, or they could have visited other healthcare services such as a family planning and gynecologic department or even other STD-providing services, including private STD providers.…”

“…26 In one study conducted in Hefei, Anhui Province, China, 77% of male index patients with urethritis or genital ulcers expressed unwillingness to inform a spouse, which was associated with feeling stigmatized. 20 Some studies 9,11,15,16 have reported low rates of partner referral for casual and unknown partners and have documented difficulties inherent in encouraging index patients to refer casual and unknown partners for treatment. However, the determinants of successful PN stratified by different partnerships have rarely been addressed.…”

“…5,8 Each method has its own inherent advantages and disadvantages in terms of feasibility, effectiveness, and cost. 13 Although provider referral used to be the main method in industrialized countries, patient referral is now prevailing in both developed and developing countries, in specialized STD services, 9,11,14 at the grassroots level, 15,16 and it even could be used in private sector and commercial pharmacies. 17,18 However, PN has not been implemented systemically in China mainly as a result of a lack of guidelines for PN as well as a lack of trained staff.…”

Regulating sexual bodies or addressing health needs? Men who have sex with men and partner notification

“…I couldn't see myself doing that (Interview 9, case, from Dublin, hairdresser, 40 years old) Moving on to the issue of casual sex, much has been written in the public health literature about the 'problem' of MSM and casual sex. It is widely reported that MSM are less able to provide sexual health advisers with contact details of their partners and, therefore, relative to women and the heterosexual population, are considered to be poor at complying with PN (Munday et al 1983, van Duynhoven et al 1998, Rogstad et al 1999, Whittington et al 2002, Hogben et al 2005. In our study, we also found some evidence to suggest that some MSM had difficulties in complying with PN because of the casual nature of some of their sexual encounters.…”