A review of partner notification for sex partners of men infected with Chlamydia.

A discussion of the feasibility and use of chlamydial screening of men requires attention to management of their partners. Because of the large numbers of chlamydial cases in the United States, public health-mediated partner notification, as a first line partner management strategy, is not practical. This article reviews the evidence for patient-based referral. We reviewed studies (1997-2007) from the United States and other industrialized nations in which men diagnosed with chlamydia were exposed to some form of partner referral instruction. Randomized controlled trial and observational data were included; where data permitted, we estimated proportions of partners notified and treated. Nine studies from 3 countries yielded 8 estimates of notification rates and 10 of treatment rates. Estimates varied according to whether patient referral was accompanied by counseling, contact slips, or medications for partners. Overall, 48% to 79% of partners seemed to be notified with a smaller proportion subsequently treated (30%-61%). Higher rates of notification and treatment were associated with various enhancements to basic referral instructions, especially if patients were offered medications to bring to partners. Data also suggest a role for contact slips. Resource constraints suggest that public health investigation should be limited to high-priority cases (e.g., where evidence of dense sexual networks exists) and monitoring of patient referral efforts.