Overcoming challenges associated with partner notification following chlamydia and gonorrhoea diagnosis in primary care: a postal survey of doctors and nursesSally B. Rose 1 , Susan M. Garrett 1 , Susan R. H. Pullon 1
1 Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
Correspondence to: Sally Rose, Department of Primary Health Care and General Practice, University of Otago, Wellington, PO Box 7343, Wellington South 6242, New Zealand. Email: email@example.com
Journal of Primary Health Care 9(2) 136-144 https://doi.org/10.1071/HC17006
Published: 30 June 2017
This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
INTRODUCTION: Sexual health guidelines recommend that partner notification and testing for reinfection are undertaken when individuals are diagnosed with bacterial sexually transmitted infections (STIs).
AIM: To understand factors influencing the effective delivery of partner notification and follow up after diagnosis of STIs in primary care, and to identify strategies that might facilitate these processes.
METHODS: A postal survey was sent to 216 primary care doctors and nurses working in 72 Wellington primary care settings. Eligible clinicians were identified from laboratory testing data, and included clinicians who had diagnosed relatively high numbers of chlamydia and/or gonorrhoea cases during a 12-month period. Response frequencies were tabulated and chi-squared testing was used to test for significant differences between doctor and nurse responses for selected items.
RESULTS: In total, 121 surveys were completed (56% response rate) by 78 doctors and 43 nurses, from 55 primary care settings (76% of sites surveyed). Responding health professionals thought that patients were open to partner notification discussion, but appreciated that this sometimes raised difficult issues for patients. Lack of time or resources to follow up, and difficulty getting hold of patients, were cited as key factors that limit assessment of partner notification success. Factors deemed likely to facilitate partner notification included readily available patient resources, training to upskill practice team members, guidance on what to say and record, and access to external advice and assistance.
DISCUSSION: This study provides insight into provider- and patient-level factors perceived to be hindering successful partner notification. Strategies that could facilitate partner notification were identified, and suggestions made as to how these could be integrated into practice.
KEYWORDS: Sexually transmitted infections; contact tracing; partner notification; primary health care; patient care management; chlamydia
References New Zealand Sexual Health Society. Best practice guidelines - Chlamydia guideline. 2015. [cited 2016 April 4]. Available from: http://www.nzshs.org/docman/guidelines/management-of-sexual-health-conditions/205-chlamydia-guideline-2015-summary/file
 New Zealand Sexual Health Society. Best practice guidelines - Gonorrhoea guideline. 2015. [cited 2016 April 4]. Available from: http://www.nzshs.org/docman/guidelines/management-of-sexual-health-conditions/165-gonorrhoea-guideline/file
 Centers for Disease Control and Prevention (CDC). Chlamydia - CDC fact sheet. Facts and brochures. 2014. [cited 2016 September 2]. Available from: http://www.cdc.gov/std/chlamydia/STDFact-chlamydia-detailed.htm
 Centers for Disease Control and Prevention (CDC). Gonorrhoea - CDC fact sheet. Facts and brochures. 2014. [cited 2016 September 2]. Available from: http://www.cdc.gov/std/gonorrhea/STDFact-gonorrhea-detailed.htm
 Ward H, Bell G. Partner notification. Medicine. 2014; 42 314–7.
| Partner notification.CrossRef |
 California Department of Public Health (CDPH). Sexually transmitted diseases (STD) control branch. Best practices for the prevention and early detection of repeat chlamydial and gonococcal infections: effective partner treatment and patient retesting strategies for implementation in California health care settings. 2011. [cited 2016 June 24]. Available from: http://www.cdph.ca.gov/programs/std/Documents/Best-Practices-for-Prevention-and-Early-Detection-of-Repeat-CT-and-GC.pdf
 Ministry of Health. Chlamydia management guidelines. 2008. [cited 2016 May 16]. Available from: http://www.moh.govt.nz/notebook/nbbooks.nsf/0/edfd568777f16125cc2574b600749353/$FILE/chlamydia-management-guidelines.pdf
 Morgan J, Donnell A, Bell A. Is everyone treated equally? Management of genital Chlamydia trachomatis infection in New Zealand. Int J STD AIDS. 2010; 21 595–600.
| Is everyone treated equally? Management of genital Chlamydia trachomatis infection in New Zealand.CrossRef | 1:STN:280:DC%2BC3cbitFaqug%3D%3D&md5=502aaccb7195b45354f9d6da8eb75a94CAS |
 Hocking JS, Parker RM, Pavlin N, et al. What needs to change to increase chlamydia screening in general practice in Australia? The views of general practitioners. BMC Public Health. 2008; 8 425
| What needs to change to increase chlamydia screening in general practice in Australia? The views of general practitioners.CrossRef |
 Cassell JA, Brook MG, Slack R, et al. Partner notification in primary care. Sex Transm Infect. 2003; 79 264–5.
| Partner notification in primary care.CrossRef | 1:STN:280:DC%2BD3szhvVCjuw%3D%3D&md5=923cfb9b4d2a6188d71d557b07a077fcCAS |
 Bangor-Jones RD, McCloskey J, Crooks L, et al. Attitudes of WA GPs to chlamydia partner notification – A survey. Aust Fam Physician. 2009; 38 448–52.
 European Centre for Disease Prevention and Control (ECDC). Public health benefits of partner notification for sexually transmitted infections and HIV. Technical report. Stockholm: ECDC; 2013. [cited 2016 December 10]. Available from: http://www.ecdc.europa.eu/en/publications/Publications/Partner-notification-for-HIV-STI-June-2013.pdf
 Duncan B, Hart G, Scoular A, et al. Qualitative analysis of psychosocial impact of diagnosis of Chlamydia trachomatis: implications for screening. BMJ. 2001; 322 195–9.
| Qualitative analysis of psychosocial impact of diagnosis of Chlamydia trachomatis: implications for screening.CrossRef | 1:STN:280:DC%2BD3M7ktF2qsA%3D%3D&md5=0da4c4961ba88787fa377efdb033797eCAS |
 Reed JL, Huppert JS, Gillespie GL, et al. Adolescent patient preferences surrounding partner notification and treatment for sexually transmitted infections. Acad Emerg Med. 2015; 22 61–6.
| Adolescent patient preferences surrounding partner notification and treatment for sexually transmitted infections.CrossRef |
 The Institute of Environmental Science and Research Ltd. Sexually transmitted infections in New Zealand: annual surveillance report 2014. Porirua: New Zealand; 2015. [cited 2016 January 1]. Available from: https://surv.esr.cri.nz/PDF_surveillance/STISurvRpt/2014/FINAL2014AnnualSTIReport.pdf
 Edwards P, Roberts I, Clarke M, et al. Increasing response rates to postal questionnaires: systematic review. BMJ. 2002; 324 1183
| Increasing response rates to postal questionnaires: systematic review.CrossRef |
 Bonevski B, Magin P, Horton G, et al. Response rates in GP surveys - trialling two recruitment strategies. Aust Fam Physician. 2011; 40 427–30.
 Claydon L. Taking sexual histories in the techno-sexual era. New Zealand Doctor 2014; (5 Nov.): http://www.nzdoctor.co.nz/in-print/2014/november-14/5-november-14/taking-sexual-histories-in-the-techno-sexual-era.aspx
 New Zealand Sexual Health Society. Best practice guidelines - Partner notification. 2012. [cited 2016 April 4]. Available from: http://www.nzshsorg/docman/guidelines/principles-of-sexual-health-care/144-partner-notification-guideline/file
 Australasian Society for HIV. Viral Hepatitis and Sexual Health Medicine (ASHM). Australasian contact tracing guidelines. [cited 2016 November 30]. Available from: http://contacttracing.ashm.org.au/
 McClean H, Radcliffe K, Sullivan A, et al. BASHH statement on partner notification for sexually transmissible infections. 2012. [cited 2016 August 25]. Available from: http://www.bashh.org/documents/4445.pdf
 Downing SG, Cashman C, McNamee H, et al. Increasing chlamydia test of re-infection rates using SMS reminders and incentives. Sex Transm Infect. 2013; 89 16–9.
| Increasing chlamydia test of re-infection rates using SMS reminders and incentives.CrossRef |
 Guy R, Wand H, Knight V, et al. SMS reminders improve re-screening in women and heterosexual men with chlamydia infection at Sydney Sexual Health Centre: a before-and-after study. Sex Transm Infect. 2013; 89 11–5.
| SMS reminders improve re-screening in women and heterosexual men with chlamydia infection at Sydney Sexual Health Centre: a before-and-after study.CrossRef |
 Kampman C, Koedijk F, Driessen-Hulshof H, et al. Retesting young STI clinic visitors with urogenital Chlamydia trachomatis infection in the Netherlands; response to a text message reminder and reinfection rates: a prospective study with historical controls. Sex Transm Infect. 2016; 92 124–9.
| Retesting young STI clinic visitors with urogenital Chlamydia trachomatis infection in the Netherlands; response to a text message reminder and reinfection rates: a prospective study with historical controls.CrossRef |