Clinical Question: Should the sex partners of patients with gonorrhea or chlamydia be treated immediately, without being examined by a physician?
Study Design: Randomized controlled trial (nonblinded)
Synopsis: Patients with gonorrhea or genital chlamydia were identified by laboratory reporting (70 percent), case reports from physicians, and identification of patients as they presented for medical care. Most had chlamydia only (78 percent) and most were women (77 percent); their mean age was 23 years. All 1,860 patients were contacted within the first 14 days after diagnosis of infection and were randomized to one of two groups: (1) usual care, with a recommendation that any sex partners seek care; and (2) expedited treatment, in which patients chose between being given medication for up to three sex partners, or having clinic staff call these partners and offer them medication directly without a clinical evaluation.
The treatment medication was consistent with standard guidelines (i.e., 400 mg of cefixime [Suprax] plus 1 g of azithromycin [Zithromax] for patients with gonorrhea, 1 g of azithromycin for patients with chlamydia). The medication packets also included condoms and information on how to prevent the transmission of sexually transmitted diseases (STDs). It is not clear how allocation was concealed or whether outcomes were assessed blindly.
Patients were contacted 10 to 18 weeks after treatment for repeat testing; approximately one third of patients in each group were lost to follow-up. Among patients with gonorrhea, infection was much less likely at follow-up if they had chosen expedited treatment for their sex partners (3 versus 11 percent; number needed to treat [NNT] = 12.5; P = .01). Among patients with chlamydia, there was a small decrease in the likelihood of infection at follow-up, but it was not statistically significant (11 versus 13 percent). The combined infection rate was slightly lower for patients who received expedited treatment (10 versus 13 percent; NNT = 33; P < .05).
Bottom Line: Giving patients a prescription for their sex partners or having a staff member contact the partners directly to offer treatment without an examination slightly reduces the risk of recurrent infection in the original patient. This is most helpful in patients with gonorrhea. (Level of Evidence: 1b–)