Level 2: Mid-level evidence
A systematic review evaluated 14 randomized trials of methods to supplement patient referral of partners in 12,389 patients with sexually transmitted infections, including gonorrhea, chlamydia, trichomoniasis, and nonspecific urethritis (BMJ. 2007;334:354; full-text available online without charge at www.bmj.com/cgi/rapidpdf/bmj.39079.460741.7Cv1. Accessed July 12, 2007). No relevant trials were identified for patients with syphilis, HIV, or other infections. All trials had methodologic weaknesses.
Six trials evaluated patient-delivered partner therapy; index patients included 4,912 women and 1,807 men. Patient-delivered partner therapy was associated with a reduced rate of persistent or recurrent infection in patients with chlamydia or gonorrhea (NNT 27), based on meta-analysis of five trials and 10% control risk. There was no significant effect in one trial of patients with trichomoniasis.
Patient-delivered sampling kits for partners of patients with chlamydia were evaluated in two trials. Index patients included 510 women and 148 men. The intervention was associated with an increased number of partners tested and an increased number of infected partners identified.
Eight trials evaluated the efficacy of providing additional information in 6,452 index patients. Written information was associated with lower rates of persistent or recurrent infection in index patient (5% vs. 12%) in one trial of 633 men with gonorrhea or chlamydia. On the other hand, written information was not associated with lower rates of persistent or recurrent infection in index patient (9% vs. 6%) in one trial of 309 women with trichomoniasis. Interactive question-and-answer sessions were associated with an increased rate of partner notification in one of two trials, but video education had no significant effects in two trials. Combination interventions with individual counseling increased the rates of partner notification and treatment in two trials.