Partner notification and partner treatment for chlamydia: attitude and practice of general practitioners in the Netherlands.

Introduction: Chlamydia prevalence remains high despite scaled-up control efforts. In the Netherlands, the majority of chlamydia patients are seen by general practitioners (GPs). Partner notification (PN) and partner treatment (PT) are addressed in GP guidelines but may not be fully covered in daily practice. As part of a larger research project into the potential of direct partner treatment for chlamydia (PICC-UP: Patient Initiated Contact treatment for Chlamydia), we investigated current practice and attitude of GPs towards PN/PT. Methods Multiple data-sources were combined. First, we collected information on current practice via two short questionnaires around a national GP conference: a pre-conference survey (n=1411) and a handout one on location (n=271). Furthermore, quantitative data on (potential) PT were obtained from prescriptions in electronic patient data from 311 practices in the NIVEL Primary Care Database and from additional data on STI consultations in a subgroup of 45 sentinel practices. Finally, we obtained more insight into GPs’ attitude towards PN/PT in a vignette study among GPs in the same network (n=268). Results In the questionnaires, the large majority of GPs (>95%) indicated to discuss PN of current and ex-partner(s) with chlamydia patients. Usually, GPs leave further steps to the patients (83%); partners are rarely treated directly (4%), except when partners are registered in the same practice (16%). Of all prescriptions of Azithromycin linked to chlamydia episodes, 2% were double dosages, presumably for PT. At STI consultations, the partners of 6/100 chlamydia patients were treated directly, either via partner prescription or double doses for the index patient. Test-results were communicated over the telephone in two thirds of chlamydia diagnoses, limiting the options for PN/PT. In the vignette study, the GPs’ attitude appeared to be more open to PT than in current practice: 16%–20% of GPs indicated willingness to provide direct PT, depending on patient/partner profile; a larger group (24%–45%) would prescribe treatment for an (unseen) partner if the patient could notify him/her first. Advantages of direct PT given by the GPs were: better transmission control because of a higher chance to treat partners (at the same time), easier, cheaper. Disadvantages mentioned were: no chance to talk and give advice to partners, over-treatment, leading to resistance, impact on patient-GP relation and privacy. GPs were concerned about prescribing antibiotics for a patient they have not seen. The opinion of 10% of GPs was that direct PT should be possible for partners of all chlamydia patients, 21% thought for many, others only for some or by exception, while 11% was not in favour of it at all. Conclusion At present, GPs in the Netherlands rarely treat partners of chlamydia cases directly, except for partners registered in the same practice. GPs may be open to options for direct PT, provided there are clear guidelines to arrange this legally and practically