Effect of expedited treatment of sex partners on recurrent or persistent gonorrhea or chlamydial infection.

BACKGROUND: Many sex partners of persons with gonorrhea or chlamydial infections are not treated, which leads to frequent reinfections and further transmission. METHODS: We randomly assigned women and heterosexual men with gonorrhea or chlamydial infection to have their partners receive expedited treatment or standard referral. Patients in the expedited-treatment group were offered medication to give to their sex partners, or if they preferred, study staff members contacted partners and provided them with medication without a clinical examination. Patients assigned to standard partner referral were advised to refer their partners for treatment and were offered assistance notifying partners. The primary outcome was persistent or recurrent gonorrhea or chlamydial infection in patients 3 to 19 weeks after treatment. RESULTS: Persistent or recurrent gonorrhea or chlamydial infection occurred in 121 of 931 patients (13 percent) assigned to standard partner referral and 92 of 929 (10 percent) assigned to expedited treatment of sexual partners (relative risk, 0.76; 95 percent confidence interval, 0.59 to 0.98). Expedited treatment was more effective than standard referral of partners in reducing persistent or recurrent infection among patients with gonorrhea (3 percent vs. 11 percent, P=0.01) than in those with chlamydial infection (11 percent vs. 13 percent, P=0.17) (P=0.05 for the comparison of treatment effects) and remained independently associated with a reduced risk of persistent or recurrent infection after adjustment for other predictors of infection at follow-up (relative risk, 0.75; 95 percent confidence interval, 0.57 to 0.97). Patients assigned to expedited treatment of sexual partners were significantly more likely than those assigned to standard referral of partners to report that all of their partners were treated and significantly less likely to report having sex with an untreated partner. CONCLUSIONS: Expedited treatment of sex partners reduces the rates of persistent or recurrent gonorrhea or chlamydial infection.

Failure of family-planning referral and high interest in advanced provision emergency contraception among women contacted for STD partner notification.

BACKGROUND: Few data are available on the risk of unintended pregnancy in women with STD or how contraceptive services can be integrated into STD control activities. OBJECTIVE: To define the risk for unintended pregnancy and assess the effectiveness of family-planning (FP) referral and interest in advanced provision emergency contraception (APEC) among women with gonorrhea or chlamydial infection. METHODS: Female participants in a randomized trial of different approaches to partner notification were interviewed, offered referral for FP services and asked if they would want APEC. RESULTS: Among participants ages 14-24, the observed past pregnancy rate and age-adjusted anticipated past pregnancy rate were, respectively, 196 and 72 per 1000 women-years. Of 474 nonpregnant participants who did not desire pregnancy, 127 (34%) were using no contraception or condoms alone, of whom 8 (6%) requested a FP appointment and 81% wanted APEC. CONCLUSIONS: Women treated for STD are at high-risk for unintended pregnancy. Although referral for FP was ineffective, interest in APEC was very high.