Warning:

This document is being maintained for historical purposes, but is now out of date. To view current guidelines please visit:

• STD Treatment Guidelines   at http://www.cdc.gov/STD/treatment

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1993 Sexually Transmitted Diseases Treatment Guidelines

09/24/1993

SUGGESTED CITATION
Centers for Disease Control and Prevention. 1993 Sexually
transmitted diseases treatment guidelines. MMWR 1993;42(No. RR-14):
{inclusive page numbers}.

CIO Responsible for this publication:
National Center for Prevention Services,
Division of Sexually Transmitted Diseases and HIV Prevention

Partner Notification and Management of Sex Partners
     
     Patients with STDs should ensure that their sex partners,
including those without symptoms, are referred for evaluation.
Providers should be prepared to assist in that effort. In most
circumstances, partners of patients with STDs should be examined.
When a diagnosis of a treatable STD is considered likely,
appropriate antibiotics should be administered even though there
may be no clinical signs of infection and before laboratory test
results are available. In most states, the local or state health
department can assist in notifying the partners of patients with
selected STDs, especially HIV, syphilis, gonorrhea, and chlamydia.

     Breaking the chain of transmission is crucial to STD control.
For treatable STDs, further transmission and reinfection can be
prevented by referral of sex partners for diagnosis, treatment, and
counseling. The following two strategies are used for partner
notification: a) patient referral (index patients notify their
partners), and b) provider referral (partners named by infected
patients are notified and counseled by health department staff).
When a physician refers an infected person to a local or state
health department, trained professionals may interview the patient
to obtain names and locating information about all of his or her
sex partners. Every health department protects the privacy of
patients in partner notification activities. Because of the
advantage of confidentiality, many patients prefer that public
health officials notify partners.

     If a patient with HIV infection refuses to notify partners
while continuing to place them at risk, the physician has an
ethical and legal responsibility to inform persons that they are at
risk of HIV infection. This duty-to-warn may be most applicable to
primary care physicians, who often have knowledge about a patient's
social and familial relationships. The decision to invoke the
duty-to-warn measure should be a last resort -- applicable only in
cases in which all efforts to persuade the patient to disclose
positive test results to those who need to know have failed.

     Although compelling ethical, theoretical, and public health
reasons exist to undertake partner notification, the efficacy of
partner notification as an STD prevention strategy is under
evaluation, and its effectiveness may be disease-specific.

     Clinical guidelines for sex partner management and
recommendations for partner notification for specific STDs are
included for each STD addressed in this report.

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