Partner Notification and Treatment

Treating the partners of STI clients is essential to prevent reinfection of the clients and to prevent further spread of the infection to others.

When referring to persons who are infected with HIV and other bloodborne viruses, the term “partner” includes not only sex partners but also injection-drug users who share needles, syringes, or other injection equipment.

Who should be notified?

If possible, all partners of an infected client should be notified of their exposure to the infection and encouraged to seek treatment. If the partners have other partners, they should also be contacted for treatment. Notification of partners can be done by the client, clinic staff, or public health authorities.

Identifying the individual who is the original infection source can be very difficult or impossible—and in terms of STI management, it is not important. All sexual partners of the client should be treated if possible, even if they have no symptoms. The diagnosis that guides treatment selection for referred partners is the same as for the client.

Importance of voluntary consent and confidentiality

Partner notification should be a voluntary process, done by the client or, when notification is done by a provider or public health authority, only with the full consent of the client, and all possible efforts must be made to protect the confidentiality of the client and his or her partner(s). In addition, partner notification must be conducted with great sensitivity, taking into account social and cultural factors, such as the possibility of violent reactions on the part of partners.

Providers should be aware of the impact an STI can have on a client’s life. When a client tells a partner about an STI infection, the partner's reaction can cause problems. Providers need to minimize these kinds of problems by ensuring confidentiality and by ensuring that clients agree to help with partner referral voluntarily. In practice, providers should aim to treat as many partners as possible, while considering the circumstances for each case.

When using syndromic management, remember that a diagnosis of vaginal discharge presents particular challenges since it may not be caused by an STI. Because of the potential for negative reactions from clients and partners when the infection may not even be caused by an STI, it is important to consider each case on an individual basis.

Strategies for partner notification

Several strategies can be used to notify partners of possible exposure:

• Client notification: The client with an STI accepts full responsibility for informing partners of their exposure and for referring them to appropriate services. This is the preferred method of partner notification.
• In some cases, clients may choose to notify partners in the presence of a provider to lend support and answer questions and address concerns.
• Provider notification: With the consent of the infected client, the provider or another health worker takes responsibility for confidentially notifying partners of the possibility of exposure.

Often, more than one strategy may be used to notify different partners of the same infected client, depending on the client, the STI, and the partner circumstances. For example, a client may feel that he or she is in a better position to notify a main partner but would prefer that the provider notify other partners. The decision about the type of notification to use should also be based on program priorities, disease morbidity, and program staffing levels.

A wide variety of other strategies are also used. In some settings, providers give appropriate drugs to the client to take to his or her partners, as opposed to having the partners come to the clinic for treatment. In some countries, mandatory contact tracing is required for certain STIs: In such cases, public health workers actually track down and inform the sexual contacts of the client and make referrals for treatment.

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