Suitable treatment should be given after considering patient compliance and the possibility of allergy, drug interaction, method of contraception, pregnancy, lactation and antimicrobial resistance. Antimicrobial treatment may be given when an sexually transmitted infection is suspected from the patient’s history, after a tentative diagnosis has been made or after it has been confirmed. Decisions on the timing of therapy should be made according to the risk of infection, the availability of diagnostic testing and the likelihood of the patient returning for results and abstaining from sexual inter-course. Treatment on epidemiologic grounds can be given to a patient whose partner is known to be infected. For example, a woman who has been having unprotected intercourse with a man with gonorrhea may be offered treatment before a diagnosis has been made. Investigations to confirm or exclude the diagnosis and exclude other sexually transmitted infections should still be performed, but treatment is given without waiting for the results.
All patients should be advised to abstain from sexual intercourse until they and their partners) have completed the treatment and tested negative (if a test of cure has been performed). Information should be offered about the disease and its treatment and how to reduce the risk of further infection and transmission. A follow-up visit is recommended to ascertain if the condition has resolved, check patient compliance and find out whether partner(s) have been notified. It is also an opportunity to provide further information and counseling for emotional and sexual difficulties. At follow-up, a test of cure should be performed for gonorrhea and trichomonas infection in all women and for chlamydia in women treated with erythromycin. As even intelligent patients may find it difficult to absorb all the information due to embarrassment and anxiety, written information should be offered.
Partner notification (contact tracing)
Partner notification involves informing sexual contacts that they have been exposed to sexually transmitted infections. The purpose is to prevent treated patients from being re-infected, detect their partners) undiagnosed infection(s) and to reduce sexually transmitted infections in the community. The rationale is that every patient has caught an sexually transmitted infection from one or more partners and may subsequently infect others. Infected partners (contacts) may not appreciate their risk of infection and/or be asymptomatic.
The benefits of partner notification are greatest for the bacterial sexually transmitted infections because they can be cured and the risk of sequelae can be reduced by prompt treatment. Partners with incurable viral sexually transmitted infections, such as genital herpes and HIV, can be given information about the infection and advice on strategies to reduce the risk of transmission. All can be offered testing for other sexually transmitted infections including HIV and advice about safer sex.
The patient is usually advised to ask her/his partner to attend a clinic for testing and treatment. It is useful to provide a contact slip or note with the diagnosis for the contact to give to their healthcare worker. In order to maintain confidentiality, no information about the patient or contact(s) should be given to anyone else without their permission. In practice, it is preferable to seek permission to disclose the name of the infection(s) that the patient acquired so that an adequate explanation of the disease, tests and any necessary treatment can be given to the contact. Naming the infection prevents the partner assuming that it is HIV A patient may be reluctant to inform her partner(s) that they have an sexually transmitted infection but be willing to provide information to enable a health professional, such as a genitourinary medicine clinic health advisor, to do so. It is common practice to contact all partners with whom the patient had sexual contact in the 3 months prior to diagnosis.