NSW Health Sexual Health Services - Standard Operating Procedures manual

NSW Sexually Transmissible Infections Programs Unit

Section 1: Clinical Prevention
Patient-delivered partner therapy for chlamydia

  • Introduction

    To provide guidelines related to provision of patient-delivered partner therapy (PDPT) for chlamydia.

    Registered nurses accredited to supply and administer STI therapies in PFSHSs can supply and administer patient-delivered partner therapy for chlamydia according to the policy directive RN supply and administration of STI therapies in publicly funded sexual health services.

    Refer to HIV and STI partner notification for the procedures related to partner notification.

  • Outcomes

    All patients with pharyngeal or anogenital chlamydia should be reviewed for eligibility for patient-delivered treatment.

    Discussion of partner notification should include patient-delivered treatment as an option where it is indicated and no contraindications to its use are identified.

  • Procedures

    When to use PDPT

    For treatment of contacts in the past six months of patients with pharyngeal or genital chlamydia where the patient:

    • has positive pharyngeal or anogenital chlamydia confirmed by nucleic acid amplification test (NAAT)
    • and has partners who are unable or unlikely to seek clinical services in a timely manner
    • and/or has repeat infections and whose partner has not been treated.

    When not to use PDPT

    Use of patient-delivered partner therapy is not recommended for:

    • men who have sex with men (MSM)
    • people who have been concurrently diagnosed with another STI
    • people whose partners have symptoms of pelvic inflammatory disease or epididymo-orchitis
    • people whose partners may have rectal chlamydia infection
    • people who have experienced recent sexual assault.

    Medication supply and record

    Azithromycin 1 gram orally as a single dose.

    One dose of treatment should be provided for each partner that the index patient is able to contact. There is no limit to the number of partners for whom treatment can be used.

    Registered nurses accredited to supply and administer STI therapies in PFSHSs can supply and administer patient-delivered partner therapy for chlamydia according to the policy directive RN supply and administration of STI therapies in publicly funded sexual health services.

    Patient education

    Provide the patient with the Patient Information sheet and the Partner Information sheet, advising the patient to pass it on to the partner with the medication. Review with the patient all relevant information related to medication administration and common medication adverse effects to pass on to partner. See  https://playsafe.health.nsw.gov.au/treatment/pdpt

    Encourage the partner to seek medical assistance directly, either by making a recommendation to the patient present, or attempting to contact the partner by telephone.

    Advise the patient to avoid sex (oral, vaginal or anal sex) for seven days after both they and their current partner(s) have been treated for chlamydia.

    Advise the patient that partners who have been provided with patient-delivered partner therapy for treatment of presumptive chlamydia should seek testing for other STIs.

    Partner notification

    Partners who are supplied treatment for chlamydia by patient-delivered partner therapy should inform any additional sexual contacts to seek testing for chlamydia and other STIs.
  • Documentation

    Document the offer of patient-delivered partner therapy in the patient’s medical record. Document whether the offer was accepted as a treatment option for their partner(s) and the number of casual and/or regular partners that patient-delivered partner therapy will be used to treat.

    If offer of patient-delivered partner therapy is declined, continue with traditional methods of partner notification as outlined in HIV and STI partner notification.

    For each PDPT pack supplied, document in the medication section of the patient’s medical record (or on a separate log) contacts for whom medication was provided and linked through to the patient’s medical record number.

    Include:

    • name and dose of medication
    • date of dispensing
    • first and last name of each partner the medication is intended for
    • partner’s address, mobile number or email address.

     

  • References and further reading

    Legal and regulatory information

    The Health Practitioner Regulation (New South Wales) Amendment (Records of Partners) Regulation 2017  allows medical practitioners treating patients for chlamydia to use the partner’s phone number or email address (to substitute for an address) when providing a prescription for azithromycin to the patient’s partners and recording in their medical record the supply of azithromycin for the partner.

    It is an established law that a health professional owes a duty of care to their patients. This duty extends to partners of patients for whom they are prescribing or providing medication. This does not mean the partner must become a patient of the clinician, as the clinician does not need to have a traditional doctor–patient relationship with the patient’s partner in order to owe the partner a duty of care. The content of the duty of care to the partner, or what the clinician must do in order to discharge that duty of care, is unclear. In general terms, in order to discharge any duty owed, it would be prudent for the person writing the prescription or supplying the medication to:

    • ensure that the patient present is advised of all relevant information (e.g. dose, side effects)
    • provide the patient with written information to pass on to the partner about these issues
    • try to encourage the partner to seek medical assistance directly (either by making a recommendation to the patient present, or attempting to contact the partner by telephone etc.)
    • form a view, based on their clinical judgment, that the risk to the patient of reinfection posed by not providing medication for the partner is greater than any potential risks associated with providing the medication for the partner.