Further reading
Appendix 1: Partner notification
Appendix 1: Partner notification
Table 1: Look back intervals for STI partner notification and recommendations for epidemiological treatment (adapted from Ref 1 with permission)
Infection Chancroid
Chlamydial infection
Epididymo-orchitis
Gonorrhoea
Hepatitis A‡
All contacts since and in the 10 days prior to onset of symptoms.
■ Male index cases with urethral symptoms: all contacts since, and in the four weeks prior to, the onset of symptoms†
■ All other index cases (i.e. all females, asymptomatic males and males with symptoms at other sites, including rectal, throat and eye): all contacts in the six months prior to presentation†
Use the look-back intervals for Chlamydial infection or gonorrhoea, if these are detected. If these infections are not detected, the look-back interval is for all contacts since, and in the six months prior to, the onset of symptoms.†
■ Male index cases with urethral symptoms: all contacts since, and in the two weeks prior to, the onset of symptoms†
■ All other index cases (i.e. all females, asymptomatic males and males with symptoms at other sites, including rectal, throat and eye): all contacts in the three months prior to presentation†
Index cases with jaundice: all contacts in the two weeks prior to, and one week after, the onset of jaundice.
Index cases without jaundice: if possible, estimate when infection is likely to have occurred based on a risk assessment.
Notify the local CCDC§, or equivalent, if an outbreak is suspected, there are household contacts, there are concerns about food or water borne infection, or the index case is a food handler.
Yes
Yes
Yes
Yes
No
Look-back intervals for partner notification* Epidemiological treatment*
Appendix 1: Partner notification
Infection Hepatitis B‡
Hepatitis C‡
PN should include any sexual contact (vaginal or anal sex, or oro-anal sex) or injection equipment sharing partners during the period in which the index case is thought to have been infectious.
The infectious period is from two weeks before the onset of jaundice until the index case is surface antigen negative. In cases without jaundice, if possible, estimate when infection is likely to have occurred based on a risk assessment. In cases of chronic infection, trace contacts as far back as any episode of jaundice, or to the time when the infection is thought to have been acquired, although this may not be possible for long look-back intervals.
Appropriate repeat serological testing of contacts should be offered.
Arrange hepatitis B screening of children who have been born to infectious women, if the child was not vaccinated at birth, according to national guidelines.5 For screening of non-sexual contacts, including household contacts, who may be at risk, discuss with the CCDC§ or equivalent.
The infectious period for acute hepatitis C is from two weeks before the onset of jaundice. However, usually there is no jaundice or history to suggest acute infection, and the look-back period for PN is to the likely time of infection (e.g. blood transfusion or first sharing of injection equipment), although this may not be possible for long look-back intervals.
However, PN should be offered in two situations only, where:
■ There was vaginal or peno-anal sexual contact and either the index case and/or the sexual contact(s) have HIV infection
■ Sharing of injection equipment occurred during the period in which the index case is thought to have been infectious
Appropriate repeat serological testing of these contacts should be offered.
Sexual transmission of HCV through heterosexual sexual contact is uncommon if both the index case and sexual contacts do not have HIV infection, and PN is not recommended for this group. Check that children born to women with hepatitis C infection have been tested for hepatitis C infection in accordance with nationally accepted guidance.6 For other non-sexual contacts thought to be at risk, discuss with the CCDC§ or equivalent.
No
No
Look-back intervals for partner notification* Epidemiological treatment*
Appendix 1: Partner notification
Infection HIV infection
LGV infection
An estimate, based on a risk assessment, of when infection is likely to have occurred should be made and PN provided to include all contacts since, and in the three months prior to, this estimate. If this is not possible, all previous partners should be contacted and offered HIV testing. The risk assessment should take into account sexual history, HIV testing history (including antenatal and Blood Transfusion Service testing history), and history of possible seroconversion illness. Additionally, any results for recent infection testing algorithm (RITA) assays8 for HIV infection, as well as CD4 cell counts and trend in CD4 cell counts should be taken into account, although careful interpretation of these data is needed.
PN for HIV infection should be part of ongoing care.
Joint Specialist Society Guidelines recommend sexual history taking at six monthly intervals after first presentation with HIV infection.9 Offer PN at follow-up visits when there are new sexual contacts whose HIV status is negative or unknown, or when new STIs are detected. Ongoing PN should include discussion about testing and re-testing of current partners and testing of children, where appropriate.
Identifying undiagnosed HIV-positive children is a priority area of unmet need and practical guidance on the approach to HIV testing of children with HIV-positive parents is available.10
Although there is no evidence-based guidance currently available, in a recent multi-disciplinary meeting11 the following were agreed:
■ HIV PN should be initiated as soon as possible, and, by four weeks after a positive HIV test, agreed actions and timelines to resolve PN should be documented. Any outcomes of PN should also be documented at this time.
■ Consensus that PN should be resolved by three months, but that if PN is still unresolved by this time it should be continued, with clear timelines, as successful PN outcomes have been reported up to 12 months after a positive HIV test.
All contacts since and in the four weeks prior to the onset of symptoms.
Post exposure prophylaxis where indicated
– see BASHH Guidelines7
Yes
Look-back intervals for partner notification* Epidemiological treatment*
Appendix 1: Partner notification
Infection
Non-specific (non-Chlamydial, non-gonococcal) urethritis in men
Pelvic inflammatory disease
Phthirus pubis infestation
Scabies infestation
Syphilis
Trichomoniasis
Male index cases with symptoms attributable to urethritis: all contacts since, and in the four weeks prior to, the onset of symptoms†
(Screening of men, without clinical features suggesting urethritis, by microscopy is not recommended practice, and therefore PN is not recommended for this group).
Use the look-back intervals for Chlamydial infection or gonorrhoea, if these are detected. If these infections are not detected, the look-back interval is for all contacts since, and in the 6 months prior to, the onset of symptoms.† ¶
All contacts since, and in the three months prior to, the onset of symptoms.
All contacts (including non sexual contacts: those with prolonged skin-to-skin contact, bed and clothes sharing, and household contacts) since, and in the two months prior to, the onset of symptoms.
■ Early syphilis:
– Primary syphilis: all contacts since, and in the three months prior to, the onset of symptoms
– Secondary and early latent syphilis: all contacts since, and in the two years prior to, the onset of symptoms
Sexual contacts of index cases with early syphilis should have serological testing for syphilis at the first visit, and have this repeated six weeks and three months from the last sexual contact with the index case.
■ Late latent and late syphilis: PN (of sexual partners and children of female patients) should be done back to the date of the last negative syphilis serology, if available. Otherwise, it should extend back over the patient’s sexual lifetime as far as is feasible. Because of the possibility of congenital syphilis, consideration should also be given to the testing of mothers of patients with late syphilis who were born outside the UK in countries where sub-optimal antenatal care was a possibility.
Any partner(s) within the four weeks prior to presentation should be treated.**
Yes
Yes
Yes – current sexual partner(s) only
Yes – current sexual partner(s) and current non-sexual contacts
Yes – in cases of early syphilis, particularly for high risk contacts and events and when contacts may not attend for repeat testing for syphilis
Not for latent and late syphilis
Yes – current partner(s) and any other partners connected with recurrent trichomoniasis.
Current contact(s) should take treatment at the same time as treatment is taken by Look-back intervals for partner notification* Epidemiological treatment*
* The look-back intervals and recommendations on epidemiological treatment stated are consistent with the BASHH Clinical Effectiveness Group (CEG) Guidelines,12 except for chlamydial infection, where there is more qualification based on the presence or absence of symptoms (the BASHH CEG Chlamydia Guideline states four weeks for [all]
symptomatic infection and six months for [all] asymptomatic infection). The recommendation in this Statement is also more consistent with the PN recommendation in the CEG BASHH guideline for gonorrhoea.
† If there have been no sexual contacts in these intervals: the most recent sexual contact beyond this interval.
‡ Acute infectious hepatitis (caused by hepatitis A, B and C) are diseases notifiable (to Local Authority Proper Officers) under the Health Protection (Notification) Regulations 2010 Health Protection Agency.13
§ CCDC Consultants in Communicable Disease Control (or Consultants in Health Protection), are responsible for the surveillance, prevention and control of communicable disease (as well as the health aspects of non-communicable environmental hazards) for a defined population within (a) defined local authority area(s). They work, along with specialist nurses, in the Health Protection Agency network of Health Protection Units (HPUs) in England. HPUs work closely with other local services involved in disease detection, surveillance and control, including local microbiology laboratories. There are equivalent systems in Wales and Scotland.14
¶ The 6 month look-back interval for PID is given arbitrarily on the basis that Mycoplasma genitalium may cause disease in women and be asymptomatically carried in men and women for an unknown period.15 Also, false negative chlamydial nucleic acid amplification tests, as well as discordant chlamydial test results, and different rates of spontaneous clearance of chlamydial infection, between sexual partners, are possible.16
** Trichomonal infection appears to resolve spontaneously in most men, usually within two weeks, with detection rates in men decreasing with increasing time from last sexual contact with female index cases. However, prolonged asymptomatic carriage has been demonstrated in some men.17,18,19
Appendix 1: Partner notification
Partner notification slip: please print this off, fill it in and hand to Pt to give to their contact(s)