Canadian STI Guidelines

Pages 46-48: Partner Notification, Partner Treatment and Counselling

Rationale

• Partner notification is the process through which sexual partners and other contacts exposed to STD are identified, located, assessed, tested, treated epidemiologically and counselled with regard to prevention.

• Contacts include sexual partners, parents of infected neonates, needle-sharing partners and people who may be involved in cases of child sexual abuse.

• Partner notification, treatment and counselling are indicated for any infection or syndrome that is predominantly transmitted sexually. This not only produces a public health benefit (e.g., disease surveillance and control) but dramatically reduces the risk of re-infection for the original patient.

• Laws and regulations in all provinces and territories require physicians to report specific diseases. For more information on specific reportable diseases in your region, contact your local public health unit (see page 236).

• While partner notification is sometimes construed as an exercise in societal vs. individual rights, its aim is clearly to assist people in honouring the individual rights of their partners to knowledge, health, and in some cases, life.

Who performs partner notification?

• Partner notification may be done by patients, health care providers or public health authorities

  • "Patient referral" may be an acceptable alternative to "provider referral" (described below). Patient referral involves patients informing their own partners without the direct involvement of health care providers or public health authorities.

  • "Provider referral" involves the notification of partners by health care providers and/or public health authorities and has shown higher rates of success in reaching partners.

• Public health authorities are responsible for ensuring that partners are notified and managed.

• If your patient does not wish to notify contacts or if contacts have not come forward:

  • Explore impediments to partner notification (see below),

  • Inform the patient of your ethical imperative to safeguard others,

  • Report to public health authorities.

Components of partner notification

• Request a notification form for STD from the local public health unit.

• Discuss the importance of partner notification with the patient.

• Develop a notification plan including which partners will be notified by whom. Stress that:

  • In the case of provider referral, partner notification is done without revealing the name of the index case to partners.

  • You are available to participate in discussions with partners.

• Obstacles to partner notification must be discussed.

  • Individual cases should be assessed for physical and emotional abuse which may result from partner notification (e.g., conjugal violence, loss of employment, etc.)

  • Individuals applying for Canadian citizenship (e.g., immigrants, refugees) may have specific concerns.

• Sexual abuse of children must be reported to your local child protection agency.

• Youth and adult cases of sexual assault and abuse should be counselled and/or referred to local crisis centres.

• All contacts of persons with curable STD (e.g., gonococcal and chlamydial infections, syphilis) should be notified and treated for the same condition as the index case.

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)
HIV	Start with recent contacts Outer limit is onset of risk behaviour
Hepatitis B	Carrier or acute infection all sexual and syringe-sharing contacts.

 

• Patients with genital herpes and patients with genital warts should be encouraged to notify their partner(s). Partners should be examined and counselled appropriately (see Genital HSV Infections, page 160, and Genital Warts and Genital HPV Infections, page 167).

• Every effort must be made to ensure that all contacts of persons with HIV are notified, counselled and tested, since rapid initiation of antiretroviral therapy is associated with a better prognosis. This is best performed by physician and patient. If contacts are difficult to locate, many public health units offer a confidential service to assist you in this process, or consult a colleague experienced in this area. Once a person living with HIV is diagnosed with AIDS, an AIDS case report form should be completed.

Confidentiality

• There are ethical, legal and professional obligations to maintain confidentiality at all times and within the bounds of other obligations such as:

  • Reporting STD to local health authorities. It may be required that personal information of a reported case of an STD be forwarded, in confidence, to provincial public health authorities

  • Where required by law (e.g., Criminal Code)

  • Reporting of sexual abuse to child protection agencies

  • Concerns about confidentiality must not impede the partner notification process.

• Confidentiality applies to all persons, including:

  • Infected persons

  • Sexual partners

  • All youth who are competent to understand their infection and care

  • Providers should apprise themselves of policies of provincial or territorial health insurance plans to guard against inadvertent disclosure to family.

Management of Co-Morbidity

• Many STDs are transmitted in the context of other medical and social challenges.

• Recurrent problems are likely unless underlying issues are dealt with.

• Specific management for conditions such as drug addiction and mental illness must be integrated into the overall health care plan.