Issue 35 / 16 September 2013

LEGISLATIVE endorsement of patient-delivered partner therapy for chlamydia will be the final stamp of approval for a treatment already in wide use, say Australian experts.

Professor Basil Donovan, head of the sexual health program at the Kirby Institute at the University of NSW, told MJA InSight that patient-delivered partner therapy (PDPT) had been a standard treatment for chlamydia “since the ’70s”.

Dr Darren Russell, director of sexual health at Cairns Hospital, said despite the legal status of PDPT not being supported by legislation in most Australian states and territories, it was still widely practised in hospitals.

“Those of us working in sexual health just do it”, Dr Russell told MJA InSight.

Professor Donovan and Dr Russell were responding to a Perspectives article in the MJA calling for specific legislative support for PDPT. (1)

PDPT — in which the patient with a sexually transmitted infection (STI) is given antibiotics to deliver to their sexual partners — has been legalised in 33 US states and is also legislated for in the Northern Territory, the MJA authors wrote.

The Royal Australasian College of Physicians Chapter of Sexual Health Medicine endorses specific PDPT guidelines, including an information sheet for sexual partners highlighting the need for a consultation and follow-up in 3 months. (2)

“We ask those Australian jurisdictions not actively planning to expressly endorse PDPT through laws permitting implementation of a proven effective strategy to do so as a matter of urgency”, the MJA authors wrote.

The authors wrote that genital Chlamydia trachomatis was the most common reportable communicable infection in Australia, with the notification rate rising for more than a decade, from 87.2 per 100 000 in 2000, to 358.9 per 100 000 in 2012.

Dr Russell said private practitioners were less inclined to use PDPT because of the legal ambiguities surrounding the treatment.

“At the hospital, however, we recommend and implement it regularly”, he said.

Professor Donovan said the legal issues had only arisen because someone asked the question.

“[PDPT] is certainly not a new practice”, he said. “It was routine to give a woman diagnosed with chlamydia a second prescription for her boyfriend. Nobody thought it was legally dodgy.

“Legal branches in health departments got asked the question and the alarm bells rang. It shows how conservative and risk-averse medicine in this country has become.”

The antibiotic of choice for the treatment of chlamydia, azithromycin, is considered safe and effective, but Dr Janette Randall, chair of NPS MedicineWise and a Brisbane-based GP, sounded a note of caution.

“In the US they needed to change the gonorrhoea guidelines because of emerging resistance, which had a huge impact on the PDPT compromise for gonorrhoea”, Dr Randall told MJA InSight.

“It’s a good case in point about what may happen with chlamydia if we are not vigilant. At the moment the public health benefits of PDPT outweigh the resistance issue, but we can’t say that will always be the case.”

Chlamydia is one of the priority areas for action within the Second National Sexually Transmissable Infections Strategy, according to NPS MedicineWise. (3)

1. MJA 2013; 199 (6): 387
2. Australasian Chapter of Sexual Health Medicine 2009; Guidelines for patient delivered partner therapy for uncomplicated genital infection caused by Chlamydia trachomatis
3. Department of Health and Ageing 2010; Second National Sexually Transmissable Infections Strategy 2010-2013

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