Public Health Ethics of Patient Delivered Partner Therapy for Chlamydia and Gonorrhea Using the Stakeholder Analysis Model

Background: Patient delivered partner therapy (PDPT) facilitates treatment of sex partners of persons with chlamydia and cephalosporin-susceptible gonorrhea with effective, safe, and inexpensive single dose oral medication without requiring them to first undergo medical evaluation. This approach, which allows clinicians to provide patients with medications or prescriptions of medications to deliver to sex partners, increases the proportion of treated partners and can reduce re-infection of index patients and transmission in the population.

Objectives: To explore the public health ethics aspects of PDPT by applying the generic stakeholder analysis model to PDPT and including the perspectives of stakeholders who represent individual and organizational considerations.

Methods: By applying the stakeholder analysis model to PDPT, we included the perspectives of patients, partners, clinicians, and public health providers;  acknowledged various interests and concerns, leveraged obligations of stakeholders; appealed to utilitarianism and fairness as ethical concepts; and complied with clinical and public health responsibilities.  Our analysis included the social dimensions of STDs, which affect transmission of infections between partners as well as partner relationships, and the role of clinicians and public health providers.

Results: To optimize patient care and public health, we suggested relevant safeguards for four processes and outcomes: (1) informed consent of patients and confidentiality of records (e.g., through staff training), (2) ensuring medical safety of partners (e.g., through patient and partner education), (3) ensuring relationship safety (e.g., through explaining advantages and limits of patient disclosure of STDs to partners), and (4) enforcing professional and legal responsibilities of clinicians and public health providers (e.g., through state laws and endorsement of professional associations).

Conclusions: It is both important and possible to minimize medical, ethical, and legal concerns; maximize benefits; and employ safeguards to optimize PDPT implementation.

Implications for Programs, Policy, and Research: Our ethical analysis of PDPT supports its implementation as one public health strategy to control persistently high rates of chlamydia and gonorrhea.