An Analysis of and Intervention in the Sexual Transmission of Disease

Abstract

Sexually transmitted diseases are a serious threat to the public health. Indeed, when an individual seeks medical treatment for a sexually transmitted disease, health authorities frequently attempt to identify, procure, and treat that individual's sexual contact(s). We conducted a comparative analysis of three alternative approaches to tracing the sexual partners of individuals diagnosed as having a sexually transmitted disease. The first approach involved counseling individuals (n = 27) infected with either gonorrhea or nongonococcal urethritis and exhorting them to procure their sexual partners for treatment. In addition to counseling, the second and third approaches involved distributing "occasion cards" for patients to use when informing sexual contacts of the need for treatment. Moreover, in the second approach, the counselor (a nurse or physician) informed infected patients (n = 19) that they and their partners could waive the $3 clinic fee contingent upon the partners seeking treatment within 1 week. In the third approach, the counselor asked infected persons (n = 19) to accept a follow-up telephone contact if their sexual partners failed to seek treatment within 1 week. The third approach was most effective. Ninety percent of the partners identified through this approach sought treatment, versus only about 60% of the partners in the other two conditions. The third approach was also the least expensive, costing about $2.95 to procure each partner for treatment.

Effectiveness and cost-effectiveness of traditional and new partner notification technologies for curable sexually transmitted infections: observational study, systematic reviews and mathematical modelling

“…Modelling the transmission dynamics of Chlamydia trachomatis provides new estimates of the average duration of asymptomatic chlamydia infection in women (433 days; 95% CI 420 to 447 days); the heterosexual per-partnership transmission probability of chlamydia [55.5%; interquartile range (IQR) 49.2% to 62.5%]; and per-sex act probability (9.5%; IQR 6.0% to 16.7%). Comparison of three individual-based models of chlamydia transmission showed that differences in sexual partnership dynamics and in infection parameter estimates partly explained the differences in model predictions of preventative interventions.…”

“…44 Twenty-one randomised controlled trials [16][17][18][19][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65] reported on eight comparisons of a method of enhanced patient referral compared with an alternative technology in patients with curable STIs ( Table 6). The updated search (5 January 2011 to 29 January 2012) identified 15 of these trials (9393 participants) [16][17][18][19][51][52][53][54][55][56][57]59,61,64,65 and six (5331 participants) 50,58,60,62,63 were included in the original review. Most trials (12) were conducted in the USA, 16,17,[50][51][52]…”

“…The updated search (5 January 2011 to 29 January 2012) identified 15 of these trials (9393 participants) [16][17][18][19][51][52][53][54][55][56][57]59,61,64,65 and six (5331 participants) 50,58,60,62,63 were included in the original review. Most trials (12) were conducted in the USA, 16,17,[50][51][52][53][54]56,58,[60][61][62] three were done in the UK, 19,55,64 two in Denmark, 63,65 and one each in Australia, 18 South Africa, 50 Uganda 57 and Zimbabwe. 59 There were no randomised controlled trials that evaluated the new UK partner notification technology of APT and no trials with reinfection as an outcome for syphilis, PID or for any STIs in men who have sex with men.…”

Behavior Change in the Funny Papers: Feedback to Cartoonists on Safety Belt Use

“…Geller (1988) reported that his nationwide petition and letter-writing campaign was effective in getting some television stars to use vehide safety belts on prime time action shows. Similarly, cards or letters have been used to prompt sexual partners to seek treatment for sexually transmitted diseases (Montesinos, Frisch, Greene, & Hamilton, 1990) and to remind patients to keep appointments with their physician (Rice & Lutzker, 1984 (wiNTER 1992) ing safety belts would place a positive model of risk reduction before millions ofreaders on a regular and repeated basis. This study was designed to evaluate the impact of a personal-advocacy approach (cf.…”

Interventions in Clinical Settings

“…This is evidenced in a number of studies of clinician-delivered interventions, many of them quite brief and involring limited training, that have yielded favorable outcomes in terms of patient behavior change in the areas of exercise promotion (Calfas et al, 1998;Long et al, 1996), decreasing alcohol use (Werch et al, 1996), hypertension control (Grueninger et al,1989), coronaq risk reduction (Scales et al, 1998), seatbelt use, weight loss, breast self-examination (see review by Logsdon et al, 1989), and STD keatment adherence (Montesinos et al, 1990). Clinician-delivered inten-entions have also bren shown to be effective in combating tobaccc~ use, even though it is an ad&-tive and notoriously intractable behavior (Kottke et al, 1992;mein et al, 1995;Morgan et al, 1998;Ockene et al, 1990; US Department of Health and Human Services, 2000).…”