Educational draft · awaiting clinical reviewThe full textbook explains uncertainty but does not replace live national or local guidance, specialist advice, or current prescribing information.
Partner notification and test-of-cure principles
Obstetrics and gynaecology · UK scope · Sources checked 27 Aug 2026 · Clinical review pending
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Some exposures have expiring interventions
A recent substantial HIV exposure, possible pregnancy after unprotected sex, sexual assault, severe STI complication or safeguarding concern cannot wait for routine partner-notification administration.
Action: Assess immediate safety, arrange HIV PEP as soon as possible and no later than 72 hours when indicated, offer time-sensitive emergency contraception, and use urgent SARC or acute-clinical pathways alongside later notification work.
Role and principles
Prevent onward transmission and reinfection through confidential, organism-specific partner notification while distinguishing eradication testing from later reinfection screening and routine follow-up.
Partner notification aims to interrupt transmission, prevent reinfection and bring asymptomatic contacts into care. It is not a demand that the index patient personally disclose in every circumstance. Begin by explaining confidentiality and asking how many contactable partners fall within the organism-specific lookback. Define partners by actual exposure rather than relationship status. Explore safety, coercion, shared devices, language, digital access and whether direct contact could reveal the index person's identity or location.
Notification can occur through patient referral, where the index person contacts partners; provider referral, where a sexual-health service contacts them without naming the index; or conditional referral, where patient referral is attempted by an agreed date before the service steps in. Anonymous digital services can supplement but should not replace a plan for testing and treatment. Choose the method collaboratively, document consent and do not place identifiable partner information in communications or records accessible to the wrong person.
Assessment and patient selection
Partner-notification need
A diagnosed transmissible infection or credible epidemiological exposure triggers identification of contactable partners within a disease-specific lookback and safety assessment.
Test-of-cure indication
Pregnancy, persistent symptoms, adherence concern, pharyngeal gonorrhoea, unknown susceptibility or alternative therapy can create an eradication-testing requirement.
Reinfection risk
Ongoing exposure, an untreated partner, younger age or a new network contact makes later retesting important despite successful initial therapy.
Unsafe patient referral
Fear, coercion, intimate-partner violence, stalking or digital surveillance means direct disclosure may be dangerous and provider-led notification should be explored.
Possible treatment failure
Persistent compatible symptoms or a positive correctly timed test without re-exposure requires adherence review, culture and specialist resistance assessment.
Red flags requiring action
A qualifying HIV exposure within 72 hours needs immediate specialist risk assessment because delaying PEP reduces the opportunity for benefit.
Pelvic pain, fever, pregnancy-related pain or bleeding, neurological or ocular symptoms, or disseminated rash requires clinical escalation before administrative follow-up.
Disclosure of coercion, violence, exploitation, stalking or fear that notification will trigger harm requires a tailored safeguarding plan and must not default to patient referral.
Baseline assessment
01Organism- and site-specific NAATFirst step
Why
Test an index patient or contact at every exposed site and perform correctly timed molecular follow-up.
Interpretation and limitations
Positive results create treatment and notification duties; an early negative after exposure or early positive after treatment may reflect a timing problem rather than true status.
02Gonococcal culture and susceptibility
Why
Establish viable infection, guide alternatives and investigate possible treatment failure or resistance.
Interpretation and limitations
Collect before treatment and again when failure is suspected; NAAT alone cannot provide antimicrobial susceptibility and may remain positive briefly after clearance.
03Quantitative RPR or VDRL
Why
Provide a baseline and serial measure of syphilis activity after stage-appropriate treatment.
Interpretation and limitations
Interpret fold-change with stage and timing; treponemal antibody persistence does not equal failure, while a rising titre can suggest reinfection or relapse.
04HIV, hepatitis and pregnancy testing
Why
Detect co-infection, window-period risk and pregnancy that changes treatment and follow-up.
Interpretation and limitations
A negative baseline may need repetition after the relevant window; pregnancy can mandate TOC and urgent specialist coordination for several infections.
Interventions
01PlanBuild a safe partner mapFirst stepA transmissible STI is diagnosed or strongly suspected and partner action is required.+
1Explain confidentiality, identify exposed partners and sites within the current disease-specific lookback, and assess risk of violence or unwanted disclosure.
2Agree patient, provider or conditional referral and record how the service can contact partners without revealing the index patient's identity.
3Specify testing, epidemiological-treatment and abstinence advice separately for each organism instead of using a generic STI script.
02Follow-upSelect the correct test and timingTreatment is complete and a question remains about eradication, reinfection or serological response.+
1Name the purpose: clinical symptom review, test of cure, later reinfection retest or syphilis serological monitoring.
2
Targets, monitoring and follow-up
Record the organism, stage or anatomical site, treatment date, adherence, abstinence advice and exact follow-up purpose so another clinician can continue safely.
Track the number of partners identified, notified, tested and treated using minimal necessary information and a secure sexual-health pathway.
Use active reminders for time-sensitive gonorrhoea TOC, pregnancy follow-up, syphilis titres and under-25 chlamydia retesting at two to six months.
Review re-exposure since treatment before interpreting a positive result, distinguishing reinfection from microbiological persistence and residual nucleic acid.
Reassess contraception, HIV PrEP or PEP eligibility, hepatitis vaccination, condom access and safeguarding as the patient's circumstances change.
Special situations
Notification need not name anyone
A provider can tell a contact that exposure occurred and offer care without revealing which patient supplied the information.
Lookback is not universal
The relevant interval follows organism, stage and symptom onset; memorising one six-month rule creates errors across different infections.
A positive NAAT needs timing
Soon after treatment, residual DNA can mimic persistence; months later, a positive result is often reinfection from renewed exposure.
Treponemal positivity can persist
Syphilis cure is monitored with history and quantitative non-treponemal titres, not by expecting treponemal antibodies to disappear.
Safety outranks disclosure pressure
When direct notification risks violence or surveillance, a confidential provider route protects both infection control and the index person.
Common pitfalls
01
Telling every patient to contact every lifetime partner instead of applying the current organism- and stage-specific lookback.
02
Disclosing the index patient's name, phone number or relationship clues in a message to a partner.
03
Ordering an immediate post-treatment NAAT and labelling residual nucleic acid as antimicrobial failure.
04
Using the phrase test of cure for a later reinfection screen or for routine syphilis titre monitoring.
05
Omitting gonococcal culture when symptoms or a correctly timed positive test suggest treatment failure.
06
Pushing patient-led notification despite intimate-partner violence, coercion or a credible risk of retaliation.
Practice
Two practice questions
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Question 1 of 2
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Obstetrics and gynaecologyOriginal SBA
Gonorrhoea test-of-cure indication
A pregnant patient has uncomplicated cervical gonorrhoea treated with ceftriaxone and her symptoms resolve. Which follow-up principle applies under current BASHH guidance?
Sources and review status5 sources · checked 27 Aug 2026 · clinical review pending+
Sources
Sources and review status
National guidance is shown before implementation-dependent detail. Apply principles in context and verify current guidance when a decision affects care. Source check completed 27 Aug 2026; clinical approval remains outstanding.
Lookback periods differ because organism biology and symptom timing differ. For chlamydia, include all partners since symptom onset plus the preceding four weeks in symptomatic penile urethral infection, and the preceding six months for other presentations. For gonorrhoea, include all partners since symptom onset plus the preceding two weeks in symptomatic penile urethral infection, or the most recent partner if longer ago, and use three months for other sites or asymptomatic infection. Treat current trichomoniasis partners and those from the preceding four weeks. Syphilis partner action is stage based: commonly three months for primary disease and two years for secondary or early latent disease, with specialist extension when the likely source lies outside the formal interval. Each partner needs testing at relevant anatomical sites.
Epidemiological treatment is also disease specific. A symptomatic chlamydia contact is tested and treated; for asymptomatic recent contacts the 2026 guideline weighs exposure within the two-week diagnostic window, pregnancy, barriers to repeat testing and onward-transmission risk rather than treating every contact automatically. Offer every gonorrhoea contact pharyngeal testing regardless of reported exposure. An asymptomatic gonorrhoea contact tested more than 14 days after exposure is treated only if positive; within 14 days, decide epidemiological treatment by pregnancy, access to repeat testing, transmission and psychosocial risk rather than treating automatically. Current partners of someone with trichomoniasis should be treated concurrently. Syphilis contacts are assessed by stage, exposure timing and serological window under specialist care.
Follow-up terminology determines timing. Test of cure evaluates persistence after therapy and must be late enough that non-viable nucleic acid does not create a false-positive NAAT. Reinfection retesting occurs later after renewed exposure risk. Chlamydia TOC is not routine in uncomplicated adherent non-pregnant care, but under-25s should be retested at two to six months. Gonorrhoea TOC is indicated for pharyngeal infection, pregnancy, persistent symptoms, unknown susceptibility or non-ceftriaxone treatment: in a symptomatic person obtain culture at least 72 hours after treatment finishes; in an asymptomatic person use NAAT at least two weeks after treatment and culture if that NAAT is positive. Trichomonas TOC is unnecessary after resolution; persistent or recurrent symptoms justify repeat NAAT, optimally four weeks after treatment started.
For syphilis, a persistent treponemal antibody is expected and cannot serve as a cure test. Follow a quantitative RPR or VDRL at stage-appropriate intervals and investigate symptoms, a rising titre or inadequate fall for reinfection, treatment failure or neurological disease. Close every pathway with a named result owner, date, contact method, abstinence advice, vaccine and HIV-prevention review. Audit outcomes such as contacts notified and treated without coercing disclosure or compromising confidentiality.
Key points
Partner notification is a clinical intervention: identify potentially exposed partners, agree a safe notification method, support testing and treatment, and document outcomes while protecting the index patient's identity.
Use infection-specific lookback periods and exposure-site questions from current BASHH guidance; one universal number is inaccurate across chlamydia, gonorrhoea, trichomoniasis and syphilis.
Offer patient referral, provider referral or a negotiated conditional approach according to preference, safety, likelihood of completion and local sexual-health capability.
A test of cure asks whether treatment eradicated the diagnosed infection; a later retest mainly seeks reinfection and is not interchangeable with symptom review.
Chlamydia test of cure is reserved for pregnancy, persistent symptoms, suspected poor adherence or another defined concern and must be delayed long enough to avoid residual DNA.
Gonorrhoea test of cure is recommended for pregnancy, pharyngeal infection, persistent symptoms, unknown susceptibility or treatment other than ceftriaxone under the 2025 guideline.
Resolved trichomoniasis does not require routine test of cure, but current partners should receive treatment and persistent or recurrent symptoms need correctly timed retesting.
Syphilis follow-up uses serial quantitative RPR or VDRL interpreted by stage, baseline titre, treatment and reinfection risk; treponemal tests often remain positive for life.
A child, person lacking decision-making capacity or adult at risk requires statutory safeguarding processes alongside confidential sexual-health care.
Suspected gonorrhoea treatment failure or resistant infection requires prompt culture, susceptibility testing and specialist or public-health involvement.
05Partner outcome audit
Why
Measure whether named or anonymous contacts were notified, assessed and treated without storing unnecessary identifying detail.
Interpretation and limitations
Incomplete outcomes prompt renewed safe contact planning; numbers support service quality but must not override consent, confidentiality or safeguarding.
Use organism, site, pregnancy, regimen and adherence to choose timing, avoiding NAAT during a residual-nucleic-acid interval.
3Interpret a positive result against re-exposure and adherence, obtaining gonococcal culture or specialist syphilis review before assuming resistance.
03Non-completionEscalate barriers without blameEscalationPartners remain uncontacted, treatment was not completed or follow-up testing is overdue.+
1Revisit safety, literacy, language, privacy, transport, cost and relationship barriers and offer a more feasible provider-led route.
2Prioritise pregnancy, resistant gonorrhoea, syphilis, HIV exposure and symptomatic complications for active specialist follow-up.
3Document attempts proportionately, protect confidential information and involve safeguarding or public health only through appropriate legal and clinical frameworks.
Recheck pregnancy, HIV and hepatitis window periods, vaccination and prevention needs while preserving a non-judgemental approach to relationship structure and partner number.