Contact tracing for chlamydia and gonorrhoea
Contact tracing means finding the sexual partners of someone with chlamydia or gonorrhoea, both sexually transmitted infections, so that they can be tested and treated.
Remember
With asymptomatic chlamydia or gonorrhoea there is no start date, so the clinic uses a longer look-back period and notifies previous partners anonymously.
Contact tracing (also called partner notification) is how the people who may have been exposed to a sexually transmitted infection are identified and told, so that they can be tested and treated. Chlamydia and gonorrhoea pass very easily between partners who are not using barrier contraception (such as condoms), and both are often asymptomatic, meaning they cause no symptoms. A partner can be infected without knowing it.
In the UK, a GUM clinic (genitourinary medicine, or sexual health, clinic) runs an anonymous service. At-risk partners are contacted, for example by text message, and advised to seek screening. They are not told who named them, which protects the patient's confidentiality.
The stretch of time that tracing covers is the look-back period. When symptoms start, they give a date to count back from. With an asymptomatic infection there is no such date, so the time of acquisition (when the infection was caught) is harder to determine and the origin is much harder to establish. A longer look-back period is therefore used, to avoid missing partners who may be infected.
Some patients are not willing or able to give contact information for their partners. In other cases, a patient may not have a partner's contact information.
Key facts
- Purpose
- to bring exposed partners to testing and treatment, which interrupts transmission (the passing on of the infection).
- Confidential
- the clinic can contact partners without naming the patient.
- Who is traced
- sexual partners within the look-back period, not just the latest one.
- Asymptomatic infection
- there is no start date, so the source is harder to establish and a longer look-back period is used.
- Chlamydia look-back
- BASHH (the British Association for Sexual Health and HIV) recommends notifying partners from the six months before presentation (the clinic visit) for an asymptomatic woman, but partners since symptom onset (when symptoms start) and during the four weeks before onset for a man with urethral symptoms (affecting the urethra, the tube that carries urine out of the body). BASHH reserves the four-week period for men with urethral symptoms and uses six months for everyone else.
- Voluntary
- it relies on the patient being willing and able to give partner details.
- Why it matters
- untreated chlamydia can progress to pelvic inflammatory disease (infection of the womb, tubes and ovaries), and untested partners can pass the infection on to others.
Exam traps
- Waiting for symptoms is wrong in chlamydia, because most people with chlamydia do not have symptoms, and waiting would leave infected partners untreated. Partner notification starts at diagnosis, whether or not symptoms are present.
- Partners who used condoms are still offered testing. Condoms lower the risk of transmission (passing the infection on), but UK guidance applies the look-back period to contacts whether or not condoms were used.
- A shorter tracing period is not right for an asymptomatic infection, because absence of symptoms does not mean the infection is recent. Asymptomatic chlamydia may have been present for a long time, so earlier partners need tracing.
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