Background: In individual-level randomized controlled trials, patient-delivered partner therapy (PDPT) reduced reinfection among patients with gonorrhea and chlamydia. The effectiveness of PDPT in practice is uncertain.
Methods: Washington State was the site of a community-randomized trial of expedited partner therapy from 2007-2010. After 2010, the Washington State Department of Health continued distributing no cost PDPT through medical providers and public health partner services (PS). Persons with gonorrhea or chlamydial infection receive PS if they are referred by a provider or randomly sampled for interview. Reinfection was defined as diagnosis with the same pathogen >30 days after initial diagnosis. We used Poisson regression with robust standard errors to assess the association between PDPT receipt and reinfection risk.
Results: From 2007-2012, 127,890 cases were reported in women and heterosexual men. Of these, 39,207 (30.7%) were interviewed. Among 35,056 chlamydia patients, 988 (2.7%), 2215 (6.1%), and 3835 (10.6%) had a recurrent infection in the subsequent 3, 6, and 12 months, respectively. Among 4,667 gonorrhea patients, 89 (1.9%), 161 (3.5%), and 238 (5.1%) were reinfected within 3, 6, and 12 months. PDPT was used to treat >1 partner by 18,114 (46.2%) of interviewed cases; roughly half received PDPT from their provider, and half from health department staff. The effect of PDPT on reinfection among gonorrhea patients varied by coinfection with chlamydia. Adjusting for gender, age, race, provider type, and provider referral for PS, receipt of PDPT was associated with a 35% decrease in the risk of recurrent gonorrhea within 12 months among gonorrhea patients without concurrent chlamydia (RR=0.65, 95%CI=0.44-0.94). PDPT was not associated with reinfection among persons with any chlamydial infection (RR=0.98, 0.92-1.04) or coinfected gonorrhea patients (RR=1.22, 0.82-1.80).
Conclusions: These findings suggest that PDPT is effective in preventing recurrent gonorrhea, but do not support its effectiveness in the prevention of recurrent chlamydial infection.