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Heterosexual partners of people with chlamydia likely to be infected
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The heterosexual partners of people with chlamydia have a high likelihood of being infected themselves, according to researchers.
In a study published in Open Forum Infectious Diseases, both partners were infected with chlamydia in 61% of pairs in which at least one partner had the disease.
“The rate of concordant chlamydial infection in this study is broadly consistent or somewhat higher than those reported in previous, smaller partner studies,” researcher Sarah Huffam, MBBS, an infectious disease and sexual health physician at the Melbourne Sexual Health Centre in in Victoria, Australia, and colleagues wrote.
The researchers conducted their study of 287 male-female pairs between January 2006 and March 2015 at Huffam’s sexual health center. A pair was included in the study if at least one partner tested positive for chlamydia at the center or within 30 days before visiting the center.
The researchers did not consider the length or exclusivity of sexual partnerships. Pairs in which the man reported sex with other men within the previous year were excluded.
The researchers found that among the 233 women with chlamydia, 76% of their male partners were also infected. Among infected women with cervicitis, 91% of their partners likewise had chlamydia. Men whose partners had taken azithromycin or doxycycline within 30 days were much less likely to become infected (7% and 25% infected, respectively).
Among the 235 men with chlamydia, 77% of their female partners also were infected. The researchers found no associations between male symptoms and signs of lower and upper genital chlamydia infection or recent antibiotic use and positive test results among their female partners.
Huffman and colleagues said their findings can add to an understanding of the true rate of chlamydia transmission among heterosexual partners.
“This study contributes additional data for the concordance of chlamydia within heterosexual partnerships, which helps improve the precision of the estimate for this parameter for mathematical modeling of chlamydia transmission,” they wrote. “Furthermore, the findings underscore the high likelihood of sexual partners of individuals with chlamydia being infected and therefore the importance of testing and appropriate management of the sexual partners of heterosexual men and women diagnosed with chlamydia.” – by Joe Green
Disclosure: Huffam reports no relevant financial disclosures. Please see the study for a list of all other authors’ relevant financial disclosures.
Perspective
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The new report by Huffam and colleagues is one of the largest studies to date investigating the frequency of urogenital chlamydial infection in male and female partners of heterosexuals with chlamydia.
The authors documented that in about 60% of partnerships, both partners were infected. Those findings build upon previous reports that showed, with newer nucleic acid-based diagnostic assays, that the frequency of transmission is greater than 50%.
Additionally, the authors found that male partners of women with cervicitis, which is inflammation of the cervix presumably due to chlamydial infection, were even more likely to be infected. The implications of the study are clear. Treatment of partners for chlamydial infection is the standard of care.
The CDC recommends different strategies to ensure that partners are treated, including partner notification by providers, partner notification by patients and expedited partner treatment. In my experience and as the former director of STD Prevention and Control Services for San Francisco, the best strategy is expedited partner treatment, in which a patient receives extra medication or an additional prescription to give to a recent partner or partners.
Azithromycin 1 g oral therapy is safe and highly effective. Expedited partner therapy is legal in 41 states and permissible in seven others. Many have worked tirelessly to ensure the legal environment allows the use of expedited partner therapy.
However, authorities cannot mandate physician practice. Physicians and providers must continue to ensure that partners are treated, have clinic or institutional protocols in place that support partner treatment and perhaps most importantly, monitor and evaluate that standard of care.
The evidence of benefit is strong. We must ensure our patients benefit from the evidence.
Reference:
CDC. Legal Status of Expedited Partner Therapy (EPT). www.cdc.gov/std/ept/legal/default.htm. Accessed August 14, 2017.
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