Martha's Case: The Unwelcome Phone Call

STI Self Learning Module

Principles And General Management For Partner Notification
Partner Notification - Two Main Approaches
Partner Notification Session With The Client

PRINCIPLES AND GENERAL MANAGEMENT FOR PARTNER NOTIFICATION

WHY INFORM, ASSESS AND TREAT PARTNERS?

• to prevent reinfection of the patient
• to limit propagation of infection within the community
• to diminish the risks of sequelae for partners
• to encourage the adoption of safer sex practices.

FOR WHICH OF THE STDs IS NOTIFICATION IMPORTANT?¹

• gonococcal infection
• syphilis
• chlamydial infection
• hepatitis B
• The following STDs are rarely seen in Canada: chancroid, lymphogranuloma venereum, and granuloma inguinale.

HOW TO PROCEED WITH PARTNER NOTIFICATION (Click here to go to Canadian Guidelines on STI)

• All partners should be notified.
• Patients participate on a voluntary basis.
• The clinician, being in a position of trust and respect, has a fundamental role to play in strongly encouraging the patient to inform his/her partners.
• The topic of partner notification should be discussed early, as soon as a patient is assessed.

TIME INTERVALS TO BE COVERED BY THE NOTIFICATION

The time periods usually recommended are the more recent intervals, which are more easily applied. However, given the variations in the period of incubation, all potentially infected partners may not be covered. These intervals can therefore be extended, if needed, at the time of case assessment.

Adapted from: Maladies transmissibles sexuellement. Guide pratique, Direction de la santé publique, Régies régionales de la Santé et des Services sociaux - Montréal-Centre et Laval, 1995. p 26.

How far back in time should you go?
Gonococcal infections, chlamydial infections, cervicitis, urethritis, PID	60 days if no partner in the last 60 days, to the last partner
Syphilis	3 to 12 months prior to the development of symptoms, depending on the stage of the disease (see page 159 of the Canadian STD Guidelines, 1998)
HIV	start with recent contacts outer limit is onset of risk behaviour
Hepatitis B carrier or acute infection	all sexual and syringe-sharing contacts.
Excerpted from the Canadian STD Guidelines, 1998, page 47

 

PARTNER NOTIFICATION - TWO MAIN APPROACHES

(1) Physician is responsible for supporting the notification process Gives pertinent information on the disease. Establishes which partners to notify. Discusses the manner in which to proceed. Establishes a referral time with the infected person and follows up on partner notification.

(2) Physician refers to Public Health Department at any time Forwards to public health personnel all pertinent information (name and address of patient, diagnosis, actions taken by the physician or the patient) Informs the patient that a public health professional will contact him/her, if needed; finds out from the patient ways of establishing contact for the public health worker.

A phone call or meeting with the patient is set up Patient is trustworthy, all partners have been notified and treated             No other measure taken Or Follow-up could not be done. Patient is unreliable. Patient doesn't wish to notify certain partners him/herself. Too many partners or difficult to reach. Some partners have not been treated. STD reinfection within the same year.         Refer to public health workers

Confidentiality is safeguarded by the Public Health Department, which will ensure that the name of the source is never identified: the notification process is followed up with the patient; the prevention messages are reinforced with the patient; direct notification of certain partners is done on the patient's request; results of follow-up are communicated to the physician.

Adapted from : Maladies transmissibles sexuellement. Guide pratique, Direction de la santé publique, Régies régionales de la Santé et des Services sociaux - Montréal-Centre et Laval, 1995. p 22.

 

PARTNER NOTIFICATION SESSION WITH THE CLIENT

Generally, clients are quite willing to answer intimate questions, but they are worried about being judged. The act of notifying partners is not only a social responsibility but also a gesture of respect and consideration.

Presenting the issue of partner notification

• Gives the client the opportunity to express his or her emotions and concerns.
• Allows the health provider to inform the client about the serious consequences of an untreated infectious disease, the risk of reinfection, the possibility of transmitting the infection to someone else or the eventual complications, even though infection may remain asymptomatic. Individuals well informed about their infection are more likely to inform their partners.

Establishing which partners to notify

• Make a list of the partners at risk of being infected, taking into account the incubation and contagious periods specific to the disease.
• Plan to contact all casual and regular partners (not only the individuals who could have transmitted the infection but also those who were exposed to it after the client became infected).
• Prioritize partners who could have been the source of the client's infection, who may not know they have been exposed, who are pregnant or who seem to have many partners.

Discuss the way to proceed

• Find out whether the client wishes to personally notify his/her partners and, if so, which one(s).
• Discuss with the client the manner in which to carry out such notification; identify the possible difficulties and the help available.
• Encourage the client to use the emotional support of friends and family members.
• Suggest that a third party (friend, physician, public health personnel) be present at the time of notification to a partner.
• Present the option that another party notify partners without the client's identity being revealed. If this option is accepted, gather the information to identify and locate partners whom the client chooses not to contact. This includes: name, sex, address, phone numbers, dates and type of exposure, age and birth date. In order to respect privacy and confidentiality in the partner notification process, sound judgement is required.

Provide follow-up

• Offer the possibility of a rapid assessment of a partner.
• Give the client written information. To facilitate the task of physicians that are subsequently contacted, make sure the client mentions the name of the infection.
• Establish deadlines for notifying partners. Notification should be done quickly - ideally within 48 hours.
• Plan a follow-up with the client after the initial notification process (face to face or by phone). You may wish to record the first names of partners so that you can refer to each partner specifically in follow-up conversations.
• Discuss with the client the safer sex practices and measures to be taken to avoid another STD in the future.

Adapted from: Maladies transmissibles sexuellement. Guide pratique, Direction de la santé publique, Régies régionales de la Santé et des Services sociaux - Montréal-Centre et Laval, 1995. p 23.