Accelerated partner therapy (APT) strategies do appear to expedite partner treatment compared with routine partner notification (PN), a UK-based study has found.

The researchers compared two models of APT with PN. In APT Hotline a doctor, health advisor or nurse assessed the partner by phone using a standard consultation guide.

The partner could collect the treatment pack from the clinic reception or have it delivered by the index patient. In APT Pharmacy, the partner attended a pharmacy for a consultation with a community pharmacist who supplied the treatment pack. The pharmacists had undergone training in the management of partners of people with chlamydia, gonorrhoea or non-gonococcal urethritis (NGU) by patient group directive (PGD) for antibiotics.

The trial involved two urban genitourinary medicine (GUM) clinics: one in central London and another outside London where it is the sole GUM service. All index patients were over 16, with a laboratory diagnosis of chlamydia, gonorrhoea or NGU and at least one partner in the UK whom the index patient could contact by phone. The patients chose the PN method for their partners.

The primary outcome measure was proportion of sexual partners for each PN intervention assumed treated 4-6 weeks after the index patient’s diagnosis. Secondary outcome measures included the proportion of partners tested for STIs and the time taken to achieve partner treatment.

The proportion of contactable partners treated was: 36% in routine PN, 59% in APT Hotline and 66% in APT Pharmacy; both APT methods were significantly better than routine practice. However, treatment of partners was not always by the APT intervention; 41% of the APT Hotline group, 48% of the APT Pharmacy group and 69% of the routine PN group were treated outside the trial venues e.g. at their GP or other sexual health service.

Overall, 92% of partners going through routine PN had STI tests (including syphilis and HIV serology); the proportion submitting urine samples for chlamydia and gonorrhoea were significantly lower in both APT groups (59% APT Hotline and 40% APT Pharmacy); the uptake of syphilis and HIV tests was very low (4% APT Hotline and 0% APT Pharmacy).

The median time from index diagnosis to partner treatment was four days (range 0 to 17) for routine PN and shorter for APT Hotline, one day (range 0-14), and APT Pharmacy two days (range 0-6).

Although both APT methods were feasible and acceptable and led to higher rates of partner treatment than routine PN, the partners of index cases appeared to have different preferences for where they wanted to be treated. The management of partners outside traditional GUM settings might also compromise opportunities to test for HIV in those at high risk.

It is a real shame that primary care was not involved in this trial as the potential benefits may be mutual.

PN has often been cited as a barrier in management of common STIs in the general practice, with many GPs and practice nurses concerned about lack of skills, lack of time and the logistics of treating patients not registered with the practice.

A network of sexual health providers working under an APT scheme involving general practice may help improve the PN pathway. Patients diagnosed and treated in primary care can have their partners treated under the APT pathway; index patients diagnosed elsewhere can have their partners treated by their GPs if preferred, which may improve uptake of STI and HIV testing.

The study group may proceed to a cluster randomised trial of APT so it is worth keeping an open mind about possible outcomes of this novel technique.

Dr Richard Ma

• Estcourt C, Sutcliffe L, Cassell J et al. Can we improve partner notification rates through expedited partner therapy in the UK? Findings from an exploratory trial of Accelerated Partner Therapy (APT) Sex Transm Infect 2012;88:21-26