New advice to GPs on chlamydia stresses the importance of partner management.
At any point in time, around one in 20 young Australians is infected with chlamydia. The majority are asymptomatic, but one in six women will develop pelvic inflammatory disease if they aren’t treated.
It is not uncommon for women to repeatedly get chlamydia, and each infection increases their risk of PID by 20%.
Australia’s national strategy emphasises the importance of partner management and retesting in routine STI care in general practice. And in a latest best practice guideline for general practitioners, sexual health researcher Dr Jacqueline Coombe, at the University of Melbourne, and her colleagues provide some tips for incorporating those priorities.
When it comes to partner notification, guidelines advise patients to inform any partners they’ve had in the last six months of their risk.
“Australian data shows that the sexual partners of nearly 75% of people diagnosed with chlamydia will also test positive,” Dr Coombe writes. Although most cases resolve spontaneously within the year, some cases can persist for years without any signs.
“Given this, it is important to inform patients that newly diagnosed infection is not always newly acquired and that the patient and/or their partner may have had the infection for some time.”
The guidelines, published in the AJGP, say that initiating a conversation about partner notification falls on the diagnosing GP.
“It is important to discuss with the index case the reasons for notifying sexual partners, help them identify which partners to notify, and identify the most appropriate method for notification.
“Although a chlamydia diagnosis can prompt feelings of shock or shame in patients, most feel that telling their sexual partners is ‘the right thing to do’.”
They provide several options for partner management.
One option may be to have the patient deliver the partner’s therapy themselves. GPs can prescribe or supply antibiotics for partner(s) without having consulted them – although states have different guidelines for this approach.
Doctors can also give their patients printed information or direct them to reputable websites to inform their partners personally.
For patients who don’t want to contact partners personally, the GP can contact sexual health clinics or public health units for advice on partner notification in more complex scenarios.
Dr Coombe and her colleagues also point GPs to resources such as postal test kits or test requests, which included Victoria’s TESTme or Queensland’s 13 HEALTH Webtest.
Other notification tools included:
- Let Them Know, https://letthemknow.org.au
- Better to Know (for Aboriginal and Torres Strait Islander people), www.bettertoknow.org.au
- Drama Down Under, www.thedramadownunder.info
The authors recommend patient-delivered partner therapy, also known as PDPT, for patients with laboratory-diagnosed chlamydia, as well as heterosexual patients whose partners have a high risk of repeat infection, and who are unable or unlikely to seek care themselves.
“Although PDPT reduces opportunity for STI screening and counselling of the partner, evidence shows that PDPT is effective at treating sexual partners and reducing the risk of repeat infection in the index case,” says Dr Coombe.
Beyond partner testing, patients also need to be retested three months later to see if they are still infected or have been re-infected. Treating the infection early lowers the risks of the patient developing PID and possible problems with fertility as a result.
As well as talking to the patient about the importance of retesting, GPs can facilitate it by organising follow-up appointments, scheduling SMS reminders, establishing a recall system or giving the patient a pathology form to give to a collection centre in three months – or a combination of these, said the authors.
“Retesting is sometimes confused with a test of cure which, unlike for gonorrhoea, is not needed for uncomplicated urogenital chlamydia infections except during pregnancy,” explained the authors. “A test of cure four weeks after treatment is recommended in pregnant women.”
To find out more about how to approach chlamydia in general practice, read the article here.