01Role and principlesWho benefits and the main preventive aims.
Partner notification is part of STI treatment because it reduces onward transmission, finds asymptomatic infection and prevents reinfection. It starts with the index patient: explain the purpose, confidentiality, choices and limits, then identify contacts within the current organism- and stage-specific lookback. Ask about anatomical exposure and timing, not only partner names or relationship status. Collect only information that supports safe contact and care.
Three broad approaches are useful. Patient referral means the index person contacts partners. Provider referral means the sexual-health service contacts them without naming the index person. Conditional referral gives the index person an agreed time to notify before the service follows up. Choice depends on preference, safety, contactability, urgency and service capability. Anonymous digital tools may help but do not guarantee privacy, access or completion.
Lookback periods and contact treatment differ between chlamydia, gonorrhoea, trichomoniasis, syphilis, HIV and viral hepatitis. They can also change with symptom onset, anatomical site or stage. Use the current pathogen guideline rather than a universal interval. A contact may need site-specific NAAT, serology, culture, vaccination, prophylaxis or epidemiological treatment. Pregnancy, timing inside an early diagnostic window and ability to return can change the plan.
Notification must not disclose the index patient through names, relationship clues, clinic portal access or unsafe devices. Ask whether direct contact could lead to violence, coercion, stalking or loss of housing. Provider referral is often safer in those circumstances. If disclosure without consent is being considered to prevent serious harm, use the minimum necessary information, follow professional and legal standards and document the reasoning.
Testing terminology matters. Test of cure asks whether treatment eradicated infection and is limited to defined pathogen, site, pregnancy, regimen or symptom situations. A later retest looks for reinfection. Gonorrhoea may require culture and susceptibility when failure is possible. An early post-treatment NAAT can remain positive from non-viable nucleic acid. Syphilis response uses quantitative non-treponemal titres rather than expecting treponemal antibodies to become negative.
Close the process actively. Record the selected referral route, agreed timing and outcome categories with minimal identifying detail. A service should know whether partners were notified, tested and treated, and should re-contact when barriers remain. Auditing numbers supports quality but does not justify pressuring the index patient, contacting someone through an unsafe route or storing unnecessary personal information.
Key points
- Partner notification identifies people exposed during the pathogen- and presentation-specific lookback, supports testing or treatment, and protects the index patient’s identity.
- Define partners by actual exposure and timing rather than relationship labels; different infections and stages use different lookback periods.
- Offer patient referral, provider referral or a negotiated conditional approach, choosing with the patient according to safety and likely completion.
- Never imply that the index patient must disclose personally. Provider messages should reveal only the minimum information needed for the contact to obtain care.
- Separate partner testing, epidemiological treatment, test of cure and later reinfection testing; their indications and timing are pathogen, site and pregnancy specific.
- Use a named result and outcome owner, document partners identified, notified, tested and treated with minimal necessary information, and revisit barriers without blame.
- Escalate urgent exposures, pregnancy, symptoms, resistance concerns, violence and safeguarding while keeping routine notification work confidential.
02Assessment and patient selectionRisk features, eligibility and important cautions.
A transmissible infection or credible exposure identifies contacts within a pathogen-, stage- and symptom-specific interval.
Violence, coercion, stalking, shared devices or fear of retaliation favours provider-led notification and a wider safety plan.
Recent HIV exposure, pregnancy risk, symptoms or resistant gonorrhoea can require same-day clinical access rather than routine messaging.
Exposure timing, symptoms, pregnancy, likely return and the organism determine whether testing alone or epidemiological treatment is appropriate.
A later positive result may follow exposure to an untreated or new partner rather than failure of the original regimen.
An undelivered message, unreturned kit or missed visit leaves the contact unresolved and should prompt a safer alternative route.
03Baseline assessmentMeasurements that guide the plan and track progress.
Read from the initial assessment onwards. Tests may run in parallel in urgent care; first-line, preferred, confirmatory, definitive and gold-standard labels appear only when the chapter explicitly states them.
- 01
Partner and exposure mapFirst step - Why
- Identify contactable partners, anatomical sites and timing within the applicable lookback.
- Interpretation and limitations
- The map guides offers of care; it is not permission to disclose the index patient or to store irrelevant relationship detail.
- 02
Organism- and site-specific testing - Why
- Test contacts at every relevant exposure site using suitable assays.
- Interpretation and limitations
- A negative site or early test does not clear untested sites or a later window; repeat and culture plans follow the pathogen.
- 03
Gonococcal culture and susceptibility - Why
- Investigate viable infection, alternative therapy or possible treatment failure.
- Interpretation and limitations
- Collect before treatment where feasible and after suspected failure; NAAT cannot provide susceptibility and early NAAT may detect residual nucleic acid.
- 04
Pregnancy and HIV exposure assessment - Why
- Identify prophylaxis, emergency contraception or treatment modifiers with narrow time windows.
- Interpretation and limitations
- Act on timing and risk immediately; baseline negative tests do not remove the need for indicated prophylaxis or later repeat testing.
- 05
Outcome audit - Why
- Verify whether partners were reached, assessed, tested and treated.
- Interpretation and limitations
- Use minimal secure data. An incomplete outcome prompts renewed planning, not blame or automatic identifiable disclosure.
04InterventionsLifestyle, treatment and escalation options.
01Notification planChoose a safe referral routeFirst stepAn index patient has a confirmed STI and two partners may have been exposed.+
- 1Explain the purpose and confidentiality of notification, then apply the current organism-specific lookback and clarify exposure sites.
- 2Ask about violence, coercion, privacy and safe communication before choosing patient, provider or conditional referral.
- 3Give each contact a route to testing or treatment without revealing the index patient and fast-track urgent pregnancy, HIV or symptom concerns.
- 4Set an outcome review date, document minimal necessary details and switch route if messages fail or safety changes.
02Possible treatment failureDistinguish persistence from reinfectionThe index patient has persistent symptoms or a positive correctly timed follow-up test.+
- 1Review adherence, regimen, vomiting, sexual contact after treatment and whether partners completed care.
- 2Obtain gonococcal culture and susceptibility when relevant and avoid assuming resistance from an early molecular result.
- 3Coordinate specialist treatment, renewed notification and public-health input according to the confirmed organism and risk.
03Disclosure concernShare only through a justified routeThe patient refuses direct notification and a clinician worries about serious preventable harm.+
- 1Explore provider referral and reasons for refusal, including fear, dependence and digital surveillance.
- 2Seek senior or information-governance advice and weigh consent, public interest, legal duties and likely harm case by case.
- 3If disclosure is justified, share the minimum necessary with an appropriate recipient and record what, why and when.
05Targets, monitoring and follow-upResponse, safety and longer-term review.
- Record infection, stage or site, lookback source, partners identified and the referral method selected with the patient.
- Track whether each contact was reached, tested and treated without retaining unnecessary identifying or relationship information.
- Reassess violence, coercion and digital safety whenever the patient reports a changed relationship or failed notification attempt.
- Separate test-of-cure dates from later reinfection retesting and assign each result to a named clinical owner.
- Escalate pregnancy, recent HIV exposure, resistant gonorrhoea, syphilis, severe symptoms and safeguarding concerns for active follow-up.
06Special situationsVariants, exceptions and circumstances that change the usual approach.
Notification can be anonymous
A provider can explain that exposure occurred and offer care without telling the contact who supplied the information.
Lookback is organism specific
A single remembered interval will misclassify contacts across different infections, stages and symptom patterns.
Safety shapes the method
Patient referral may be inappropriate where direct disclosure creates a credible risk of violence or surveillance.
Outcome needs verification
Sending a message is an attempt; successful notification, clinical assessment and treatment are distinct outcomes.
Cure differs from reinfection
Eradication testing and later rescreening answer different questions and therefore use different timing.
07Common pitfallsFrequent interpretation and management errors.
- 01
Using one six-month lookback for every STI, site, stage and symptom presentation.
- 02
Pressuring an index patient to disclose directly when provider referral could preserve safety and confidentiality.
- 03
Including the index patient’s name or recognisable relationship detail in a partner message.
- 04
Calling an early post-treatment NAAT resistance without considering residual nucleic acid, adherence and re-exposure.
- 05
Treating a sent text or kit as proof that the contact received testing and appropriate treatment.
- 06
Allowing routine contact tracing to delay HIV PEP, emergency contraception, acute assessment or safeguarding.