Partner Services
The term “partner services” refers to a continuum of clinical evaluation, counseling, diagnostic testing, and treatment designed to increase the number of infected persons brought to treatment and to reduce transmission among sexual networks. This continuum includes efforts of health departments, medical providers, and patients themselves. The term “public health partner services” refers to efforts by public health departments to identify the sex and needle-sharing partners of infected persons to ensure their medical evaluation and treatment. Health departments are increasingly incorporating referral to additional services, as indicated, into the partner services continuum. Aside from the general benefit to patients and partners, service referrals and linkage can mitigate the circumstances that increase risk for future STI and HIV acquisition.
The types and comprehensiveness of public health partner services and the specific STIs for which they are offered vary by public health agency, their resources, and the geographic prevalence of STIs. In most areas of the United States, health departments routinely attempt to provide partner services to all persons with infectious syphilis (primary or secondary) and persons with a new diagnosis of HIV infection. Health departments should provide partner services for persons who might have cephalosporin-resistant gonorrhea. In contrast, relatively few U.S. health departments routinely provide STI partner services to persons with gonorrhea, chlamydia, trichomoniasis, or other STIs (105). Because STI diagnoses often can serve as risk markers for HIV acquisition (83), public health services might include follow-up of MSM with an STI to offer HIV PrEP. Public health services can also include HIV and STI prevention interventions including HIV and STI testing, linkage and relinkage of persons with HIV infection to HIV care clinics, and referral of partners of persons with STIs or HIV infection to HIV PrEP, as indicated (106–109). Clinicians should familiarize themselves with public health practices in their area; however, in most instances, providers should understand that responsibility for discussing the treatment of partners of persons with STIs rests with the diagnosing provider and the patient. State laws require a good faith effort by the provider to inform partners, and providers should familiarize themselves with public health laws.
Clinicians who do not notify partners of patients directly can still provide partner services by counseling infected persons and providing them with written information and medication to give to their partners (if recommended and allowable by state law), directly evaluating and treating sex partners, and cooperating with state and local health departments. Clinicians’ efforts to ensure treatment of patients’ sex partners can reduce the risk for reinfection and potentially diminish transmission of STIs (110). Therefore, clinicians should encourage all persons with STIs to notify their sex partners and urge them to seek medical evaluation and treatment. Exceptions to this practice include circumstances posing a risk for intimate partner violence (111). Available data are limited regarding the rate of intimate partner violence directly attributable to partner notification (112,113); however, because of the reported prevalence of intimate partner violence in the general population (114), providers should consider the potential risk before notifying partners of persons or encouraging partner notification. Time spent counseling patients about the importance of notifying partners is associated with improved notification outcomes (115). When possible, clinicians should advise persons to bring their primary sex partner with them when returning for treatment and should concurrently treat both persons. Although this approach can be effective for a main partner (116,117), it might not be a feasible approach for additional sex partners. Evidence indicates that providing patients with written information to share with sex partners can increase rates of partner treatment (110).
Certain health departments now use technology (e.g., email, texting, mobile applications, and social media outlets) to facilitate partner services for locating and notifying the sex partners of persons with STIs, including HIV (118,119). Patients now have the option to use Internet sites to send anonymous email or text messages advising partners of their exposure to an STI (120); anonymous notification via the Internet is considered better than no notification at all. However, because the extent to which these sites affect partner notification and treatment is uncertain, patients should be encouraged to notify their partners in person or by telephone, email, or text message; alternatively, patients can authorize a medical provider or public health professional to notify their sex partners.