WEDNESDAY, Feb. 16, 2005 (HealthDay News) -- Giving people diagnosed with chlamydia or gonorrhea free antibiotic "partner packets" works better than simply asking them to warn their partners that they might be infected, new research suggests.
While legal issues remain, the strategy does seem to lower stubborn rates of patient re-infection for these common sexually transmitted diseases (STDs), which can cause both pain and infertility.
"This has been a frustrating problem for private practitioners for decades -- the fact that you see a patient for an STD and then they come back re-infected," said Dr. Emily J. Erbelding, an infectious disease specialist at Johns Hopkins School of Medicine and chief of clinical services for STD clinics at the Baltimore City Health Department. She believes partner packets "just makes it easier and less of a hassle" for both partners to get rid of infection.
A study published Feb. 17 in the New England Journal of Medicine seems to support that view. In the study, researchers at the University of Washington, Seattle, and the U.S. Centers for Disease Control and Prevention offered one of two options to 931 people treated for either gonorrhea or chlamydia at Seattle-area STD clinics.
Half of the people were simply told to inform their sex partners of their infected status and to encourage those partners to seek medical attention. "Unfortunately, in most cases, doctors will never find out whether that ever happens or not," said lead researcher Dr. Matthew R. Golden, a professor of medicine at the University of Washington and acting director of the Public Health-Seattle and King County STD Control Program.
The other half received free packets of antibiotics for their partner when they picked up their own prescriptions at their local pharmacy. The packets contained clear, detailed instructions as to their purpose and use, including a warning that anyone with a history of allergy to antibiotics should not use the medications.
The researchers then waited for up to 19 weeks to see if either method was better at preventing rates of re-infection among the participants.
According to Golden, the handouts "increased the number of sex partners who got treated and decreased the original partner's risk of re-infection." Just 3 percent of people given partner packets suffered persistent or recurrent gonorrhea infection, compared with 11 percent of those who were simply told to inform their partners of their infected status. Rates for chlamydia infection were affected less dramatically than for gonorrhea, but the antibiotic handouts did drive chlamydia re-infection rates down slightly, the researchers noted.
Partner packets work because, without them, "the partner would otherwise have to take time off from work, they might not have insurance, and they might not know where convenient services might be obtained," explained Erbelding, who is also the co-author of a journal commentary on the Seattle study.
She pointed out that, in most cases, chlamydia shows no symptoms in either women or men, whereas gonorrhea is asymptomatic in most women -- providing less incentive for potentially infected individuals to seek out care. In that case, simply taking a course of free antibiotics is probably the easiest route to making sure any infection is taken care of, she said.
Still, legal hurdles remain before handing out partners packs becomes common practice at clinics everywhere. "In most states, it's either illegal or its legal status is uncertain," Erbelding said. "Generally, physicians are supposed to give prescriptions to people they have a relationship with."
But lawmakers "haven't really contemplated this type of situation, Erbelding said. "We're talking about STDs here. You've got to think a little bit beyond the usual."
While STD rates have been falling "incrementally" over the past few decades, "it's nowhere near the goal the U.S. public health services have set," she said. Stubborn pockets of infection and re-infection remain, especially in poorer areas of the South.
"We estimate that there are about 3 million new chlamidial infections every year, and a million gonococcal infections," Golden said.
He said it would be great if public health clinics had the money and manpower to track down the partners of infected people, but cutbacks and new public health priorities, such as HIV, have made that impossible. At the same time, there's a growing consensus that simply asking people to inform their partners of their status isn't working.
"We would love everyone who thinks they might be infected to come to the clinic to get evaluated -- that's always the best option," Golden said. In handing out partner packets, "we're making a compromise. We recognize that, sometimes, that just doesn't happen. In the end, it's more important that partners get treated than if we insist on this traditional standard."
More information
For more on sexually transmitted diseases, go to the National Institutes of Health.
