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<h6><!--mstheme--><font color="#003366"><font face="Verdana"><a name="These">These</a> guidelines have
been produced as a working document for all Health Advisers based in Departments of
Genito-Urinary Medicine. It is anticipated that they will also be of benefit to
those interested in the issues of partner notification in sexually transmitted diseases.</font><!--mstheme--></font></h6>
<h2 align="center" style="text-align:center"><!--mstheme--><font color="#003366"><font face="Verdana">PARTNER NOTIFICATION GUIDELINES</o:p></font><!--mstheme--></font></h2>
<h5><!--mstheme--><font color="#003366"><font face="Verdana"> Contents</font><!--mstheme--></font></h5>
<!--mstheme--></font><!--msthemelist--><table border="0" cellpadding="0" cellspacing="0" width="100%">
<!--msthemelist--><tr><td valign="baseline" width="42"><img src="../_themes/shastd2/shasbul3.gif" width="35" height="24" hspace="3" alt="bullet"></td><td valign="top" width="100%"><!--mstheme--><font face="verdana, Arial, Helvetica"><p class="MsoNormal"><font face="Verdana">
<a href="#INTRODUCTION">Introduction</a></font></p>
<!--mstheme--></font><!--msthemelist--></td></tr>
<!--msthemelist--><tr><td valign="baseline" width="42"><img src="../_themes/shastd2/shasbul3.gif" width="35" height="24" hspace="3" alt="bullet"></td><td valign="top" width="100%"><!--mstheme--><font face="verdana, Arial, Helvetica"><p class="MsoNormal"><font face="Verdana">
<a href="# Aims of Partner Notification">The aims of partner notification</a></font></p>
<!--mstheme--></font><!--msthemelist--></td></tr>
<!--msthemelist--><tr><td valign="baseline" width="42"><img src="../_themes/shastd2/shasbul3.gif" width="35" height="24" hspace="3" alt="bullet"></td><td valign="top" width="100%"><!--mstheme--><font face="verdana, Arial, Helvetica"><p class="MsoNormal"><font face="Verdana">
<a href="#Definitions of Partner Notification">Definitions of Partner Notification</a></font></p>
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<!--msthemelist--><tr><td valign="baseline" width="42"><img src="../_themes/shastd2/shasbul3.gif" width="35" height="24" hspace="3" alt="bullet"></td><td valign="top" width="100%"><!--mstheme--><font face="verdana, Arial, Helvetica"><p class="MsoNormal"><font face="Verdana">
<a href="#Principles of Partner Notification">Principles of partner notification</a></font></p>
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<!--msthemelist--><tr><td valign="baseline" width="42"><img src="../_themes/shastd2/shasbul3.gif" width="35" height="24" hspace="3" alt="bullet"></td><td valign="top" width="100%"><!--mstheme--><font face="verdana, Arial, Helvetica"><p class="MsoNormal"><font face="Verdana">
<a href="#Issues for Consideration in the Practice of Partner Notification">Issues in the
practice of partner notification</a></font></p>
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<!--msthemelist--><tr><td valign="baseline" width="42"><img src="../_themes/shastd2/shasbul3.gif" width="35" height="24" hspace="3" alt="bullet"></td><td valign="top" width="100%"><!--mstheme--><font face="verdana, Arial, Helvetica"><p class="MsoNormal"><font face="Verdana">
<a href="#Methodology of Partner Notification">The methodology of partner notification</a></font></p>
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<!--msthemelist--><tr><td valign="baseline" width="42"><img src="../_themes/shastd2/shasbul3.gif" width="35" height="24" hspace="3" alt="bullet"></td><td valign="top" width="100%"><!--mstheme--><font face="verdana, Arial, Helvetica"><p class="MsoNormal"><font face="Verdana">
<a href="#Issues for Consideration in the Management of Partner Notification">Issues in
the management of partner notification</a></font></p>
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<p class="MsoNormal"><font face="Verdana"> </font></p>
<h3><!--mstheme--><font color="#003366"><font face="Verdana"><a name="INTRODUCTION">INTRODUCTION</a> </font><!--mstheme--></font></h3>
<p class="MsoBodyText"><font face="Verdana">In 1993 the Society of Health Advisers in
Sexually Transmitted Diseases (SHASTD) established a working group to produce guidelines
on partner notification. This working group consisted of health advisers from
Departments of Genito-Urinary Medicine (GUM) from within the United Kingdom, representing
both urban and rural areas. Through this initiative these guidelines have been
produced. For the purposes of these guidelines the term partner notification will be
synonymous with contact tracing.</font></p>
<p class="MsoNormal" style="text-align:justify"><font face="Verdana"> The United
Kingdom saw the establishment of the first contact tracing projects for sexually
transmitted diseases (STDs) over forty years ago. Initially these projects were
developed to identify, diagnose and treat the contacts of persons with venereal diseases,
essentially gonorrhoea and syphilis. It was during this period that the availability
of treatment for all STDs highlighted the public health issues and identified contact
tracing as an important part of control. Although these early initiatives were only
a part of the wider public health approach, it is recognised that contact tracing has
played and continues to play a fundamental role in the control of STDs in the UK.
These continue to be the basis of the management of partner notification as we know it
today, which has developed over the years to become a complex and challenging component of
the role of the health adviser.</font></p>
<h3 style="text-align:justify"><!--mstheme--><font color="#003366"><a name=" Aims of Partner Notification"><font face="Verdana"> Aims of Partner Notification</font></a><!--mstheme--></font></h3>
<p style="text-align:center"><font face="Verdana"> <o:p>The aim of partner notification
is to break the chain of transmission of STDs and reduce the national rates of infections
through:-</font></p>
<!--mstheme--></font><!--msthemelist--><table border="0" cellpadding="0" cellspacing="0" width="100%">
<!--msthemelist--><tr><td valign="baseline" width="42"><img src="../_themes/shastd2/shasbul3.gif" width="35" height="24" hspace="3" alt="bullet"></td><td valign="top" width="100%"><!--mstheme--><font face="verdana, Arial, Helvetica"><p class="MsoNormal"><font face="Verdana"> <o:p></o:p>Identifying,
counselling and screening sexual partners/contacts of index patients and offering
treatment if appropriate.</font></p>
<!--mstheme--></font><!--msthemelist--></td></tr>
<!--msthemelist--><tr><td valign="baseline" width="42"><img src="../_themes/shastd2/shasbul3.gif" width="35" height="24" hspace="3" alt="bullet"></td><td valign="top" width="100%"><!--mstheme--><font face="verdana, Arial, Helvetica"><p class="MsoNormal" style="margin-left:.25in;text-indent:-.25in;mso-list:l3 level1 lfo1;
tab-stops:list .25in"><font face="Verdana">Education and promotion of sexual health on an individual basis.</font></p>
<!--mstheme--></font><!--msthemelist--></td></tr>
<!--msthemelist--></table><!--mstheme--><font face="verdana, Arial, Helvetica">
<p class="MsoNormal"><font face="Verdana"> <o:p></o:p>Partner
notification should be available for all those patients/clients with a diagnosis of an
STD.</font></p>
<h3><!--mstheme--><font color="#003366"><a name="Definitions of Partner Notification"><font face="Verdana">Definitions of Partner Notification</font></a><!--mstheme--></font></h3>
<h5><!--mstheme--><font color="#003366"><font face="Verdana">'Partner notification'</font><!--mstheme--></font></h5>
<p class="MsoNormal"><em><font face="Verdana"> <o:p></o:p>“The spectrum of public
health activities in which sexual partners of individuals with STD or HIV infection are
notified, counselled on their exposure and offered services".</font></em></p>
<p class="MsoNormal"><font face="Verdana">The partner should be given information on:</font></p>
<!--mstheme--></font><!--msthemelist--><table border="0" cellpadding="0" cellspacing="0" width="100%">
<!--msthemelist--><tr><td valign="baseline" width="42"><img src="../_themes/shastd2/shasbul3.gif" width="35" height="24" hspace="3" alt="bullet"></td><td valign="top" width="100%"><!--mstheme--><font face="verdana, Arial, Helvetica"><p class="MsoNormal"><font face="Verdana">The
nature of the exposure and the risk of infection</font></p>
<!--mstheme--></font><!--msthemelist--></td></tr>
<!--msthemelist--><tr><td valign="baseline" width="42"><img src="../_themes/shastd2/shasbul3.gif" width="35" height="24" hspace="3" alt="bullet"></td><td valign="top" width="100%"><!--mstheme--><font face="verdana, Arial, Helvetica"><p class="MsoNormal" style="margin-left:.25in;text-indent:-.25in;mso-list:l6 level1 lfo2;
tab-stops:list .25in"><font face="Verdana">The need for, and location of the appropriate clinical services; and</font></p>
<!--mstheme--></font><!--msthemelist--></td></tr>
<!--msthemelist--><tr><td valign="baseline" width="42"><img src="../_themes/shastd2/shasbul3.gif" width="35" height="24" hspace="3" alt="bullet"></td><td valign="top" width="100%"><!--mstheme--><font face="verdana, Arial, Helvetica"><p class="MsoNormal" style="margin-left:.25in;text-indent:-.25in;mso-list:l6 level1 lfo2;
tab-stops:list .25in"><font face="Verdana">The need to avoid sexual contact until treated and/or counselled</font></p>
<!--mstheme--></font><!--msthemelist--></td></tr>
<!--msthemelist--></table><!--mstheme--><font face="verdana, Arial, Helvetica">
<h5><!--mstheme--><font color="#003366"><font face="Verdana"> 'Patient referral'</font><!--mstheme--></font></h5>
<p class="MsoBodyText"><em><font face="Verdana">“The approach whereby an infected
patient is encouraged to notify partner(s) of their possible infection without the direct
involvement of health care providers. The patient may: (i) provide the partner with
information; (ii) accompany the partner to the clinic; or (iii) simply hand over a contact
slip. The health care provider may counsel patients about the information to be
passed on to their partners and the methods of providing it.”</font></em></p>
<h5><!--mstheme--><font color="#003366"><font face="Verdana">'Provider referral'</font><!--mstheme--></font></h5>
<p class="MsoBodyText"><em><font face="Verdana">“The approach whereby health care
providers or other health care workers notify a patient’s partner(s). The
infected patient provides information on partner(s) to a health care worker, who then
confidentially traces and notifies the partner(s) directly.”</font></em></p>
<p class="MsoBodyText" align="right"><small><font face="Verdana">(World Health
Organisation Management of Patients with STDs)</font></small></p>
<h3><!--mstheme--><font color="#003366"><a name="Principles of Partner Notification"><font face="Verdana">Principles of Partner Notification</font></a><!--mstheme--></font></h3>
<p class="MsoNormal" style="text-align:center"><em>“Partner notification should be
voluntary and not punitive in any way. Index patients should have full access to
available services whether or not they are willing to co-operate in notification
activities.”</em></p>
<p class="MsoNormal" style="text-align:justify" align="right"><font face="Verdana"> <o:p><small>(Department
of Health Guidance on partner notification for HIV infection) PLCO(92)5</small></font></p>
<h4 style="text-align:justify"><!--mstheme--><font color="#003366"><a name="Confidentiality"><font face="Verdana">Confidentiality</font></a><!--mstheme--></font></h4>
<p class="MsoNormal" style="text-align:justify"><font face="Verdana">Confidentiality is of
paramount importance in the area of GUM. All health professionals are bound by a
common law duty of confidentiality. In addition to this the NHS (Venereal Diseases)
Regulations 1974 and the National Health Service Trust (VD) Directive 1991 offer
additional protection to patients rights of confidentiality. The records of all
patients attending a GUM must remain confidential to that department.</font></p>
<h4 style="text-align:justify"><!--mstheme--><font color="#003366"><a href="../professional_interest/ethics"><font face="Verdana">Health Adviser Code
of Ethics</font></a><!--mstheme--></font></h4>
<p class="MsoNormal" style="text-align:justify"><font face="Verdana">The agreement and
co-operation of the index patient must be established before partner notification can be
undertaken. It is important that the index patient understands the need to inform
partner(s)/contacts who have possibly been exposed to an STD. To enable this to
happen clear, detailed and relevant information about the nature of the infection needs to
be obtained and its modes of transmission clarified. The Society believes that all
health advisers should work to the <a href="../professional_interest/ethics">SHASTD Code of Ethics</a> in order
to provide a professional and ethical health advising service. Partner notification
should be undertaken within the context of a full GUM service. This includes a full
screening, diagnostic and treatment service to include not only partner notification but
also health education/promotion and counselling. It is important that all patients
have the opportunity to explore factors which affect the individual risk to their own
sexual health.</font></p>
<h3 style="text-align:justify"><!--mstheme--><font color="#003366"><a name="Issues for Consideration in the Practice of Partner Notification"><font face="Verdana">Issues for Consideration in the Practice of Partner Notification</font></a><!--mstheme--></font></h3>
<p class="MsoNormal" style="text-align:justify"><em><strong><font face="Verdana">Partner
notification should be non-coercive, confidential</font></strong></em></p>
<p class="MsoNormal" style="text-align:justify" align="center"><font face="Verdana"><em><strong>and
should not be seen as punitive</strong></em> <o:p></o:p></font></p>
<!--mstheme--></font><!--msthemelist--><table border="0" cellpadding="0" cellspacing="0" width="100%">
<!--msthemelist--><tr><td valign="baseline" width="42"><img src="../_themes/shastd2/shasbul3.gif" width="35" height="24" hspace="3" alt="bullet"></td><td valign="top" width="100%"><!--mstheme--><font face="verdana, Arial, Helvetica"><p class="MsoNormal" style="margin-left:.25in;text-align:justify;text-indent:
-.25in;mso-list:l4 level1 lfo3;tab-stops:list .25in"><font face="Verdana">Those patients with an STD should have partner notification issues raised
with them by a health adviser at the time of diagnosis.</font></p>
<!--mstheme--></font><!--msthemelist--></td></tr>
<!--msthemelist--><tr><td valign="baseline" width="42"><img src="../_themes/shastd2/shasbul3.gif" width="35" height="24" hspace="3" alt="bullet"></td><td valign="top" width="100%"><!--mstheme--><font face="verdana, Arial, Helvetica"><p class="MsoNormal" style="margin-left:.25in;text-align:justify;text-indent:
-.25in;mso-list:l4 level1 lfo3;tab-stops:list .25in"><font face="Verdana">If an index patient refuses the opportunity of seeing a health adviser, the
refusal should be noted. In such circumstances the doctor should raise the issue of
partner notification and should be responsible for recording the relevant information.</font></p>
<!--mstheme--></font><!--msthemelist--></td></tr>
<!--msthemelist--><tr><td valign="baseline" width="42"><img src="../_themes/shastd2/shasbul3.gif" width="35" height="24" hspace="3" alt="bullet"></td><td valign="top" width="100%"><!--mstheme--><font face="verdana, Arial, Helvetica"><p class="MsoNormal" style="margin-left:.25in;text-align:justify;text-indent:
-.25in;mso-list:l4 level1 lfo3;tab-stops:list .25in"><font face="Verdana">A full sexual history of the index patient needs to be obtained in order to
facilitate partner notification.</font></p>
<!--mstheme--></font><!--msthemelist--></td></tr>
<!--msthemelist--><tr><td valign="baseline" width="42"><img src="../_themes/shastd2/shasbul3.gif" width="35" height="24" hspace="3" alt="bullet"></td><td valign="top" width="100%"><!--mstheme--><font face="verdana, Arial, Helvetica"><p class="MsoNormal" style="margin-left:.25in;text-align:justify;text-indent:
-.25in;mso-list:l4 level1 lfo3;tab-stops:list .25in"><font face="Verdana">The risk of each sexual contact needs to be identified by the index patient
and the health adviser.</font></p>
<!--mstheme--></font><!--msthemelist--></td></tr>
<!--msthemelist--><tr><td valign="baseline" width="42"><img src="../_themes/shastd2/shasbul3.gif" width="35" height="24" hspace="3" alt="bullet"></td><td valign="top" width="100%"><!--mstheme--><font face="verdana, Arial, Helvetica"><p class="MsoNormal" style="margin-left:.25in;text-align:justify;text-indent:
-.25in;mso-list:l4 level1 lfo3;tab-stops:list .25in"><font face="Verdana">Partner notification and especially provider referral can often raise
complex issues and it is important that this is undertaken by skilled and experienced
health advisers.</font></p>
<!--mstheme--></font><!--msthemelist--></td></tr>
<!--msthemelist--><tr><td valign="baseline" width="42"><img src="../_themes/shastd2/shasbul3.gif" width="35" height="24" hspace="3" alt="bullet"></td><td valign="top" width="100%"><!--mstheme--><font face="verdana, Arial, Helvetica"><p class="MsoNormal" style="margin-left:.25in;text-align:justify;text-indent:
-.25in;mso-list:l4 level1 lfo3;tab-stops:list .25in"><font face="Verdana">Once identified, the most appropriate method of partner notification should
be implemented. (See <a href="#Methodology of Partner Notification">methodology</a>).</font></p>
<!--mstheme--></font><!--msthemelist--></td></tr>
<!--msthemelist--><tr><td valign="baseline" width="42"><img src="../_themes/shastd2/shasbul3.gif" width="35" height="24" hspace="3" alt="bullet"></td><td valign="top" width="100%"><!--mstheme--><font face="verdana, Arial, Helvetica"><p class="MsoNormal" style="margin-left:.25in;text-align:justify;text-indent:
-.25in;mso-list:l4 level1 lfo3;tab-stops:list .25in"><font face="Verdana">The health adviser should be supportive to the index patient during the
process of partner notification, whether patient or provider referral.</font></p>
<!--mstheme--></font><!--msthemelist--></td></tr>
<!--msthemelist--><tr><td valign="baseline" width="42"><img src="../_themes/shastd2/shasbul3.gif" width="35" height="24" hspace="3" alt="bullet"></td><td valign="top" width="100%"><!--mstheme--><font face="verdana, Arial, Helvetica"><p class="MsoNormal" style="margin-left:.25in;text-align:justify;text-indent:
-.25in;mso-list:l4 level1 lfo3;tab-stops:list .25in"><font face="Verdana">Partner notification is usually ongoing and follow-up is part of the
management process.</font></p>
<!--mstheme--></font><!--msthemelist--></td></tr>
<!--msthemelist--><tr><td valign="baseline" width="42"><img src="../_themes/shastd2/shasbul3.gif" width="35" height="24" hspace="3" alt="bullet"></td><td valign="top" width="100%"><!--mstheme--><font face="verdana, Arial, Helvetica"><p class="MsoNormal" style="margin-left:.25in;text-align:justify;text-indent:
-.25in;mso-list:l4 level1 lfo3;tab-stops:list .25in"><font face="Verdana">Partner notification activity needs to be adequately documented and cross
referenced. (See <a href="#Methodology of Partner Notification">methodology</a>).</font></p>
<!--mstheme--></font><!--msthemelist--></td></tr>
<!--msthemelist--><tr><td valign="baseline" width="42"><img src="../_themes/shastd2/shasbul3.gif" width="35" height="24" hspace="3" alt="bullet"></td><td valign="top" width="100%"><!--mstheme--><font face="verdana, Arial, Helvetica"><p class="MsoNormal" style="margin-left:.25in;text-align:justify;text-indent:
-.25in;mso-list:l4 level1 lfo3;tab-stops:list .25in"><font face="Verdana">The utilisation of the established health adviser network within GUM in the
UK is an intrinsic part of the successful management of partner notification.</font></p>
<!--mstheme--></font><!--msthemelist--></td></tr>
<!--msthemelist--></table><!--mstheme--><font face="verdana, Arial, Helvetica">
<p class="MsoNormal" style="text-align:justify"><font face="Verdana"> <o:p><em><strong>With HIV the issues of
partner notification are complex. In addition to the basic principles of good
practice the issue of partner notification should be raised at the pre-test discussion.</strong></em></font></p>
<h3 style="text-align:justify"><!--mstheme--><font color="#003366"><a name="Methodology of Partner Notification"><font face="Verdana">Methodology of Partner Notification</font></a><!--mstheme--></font></h3>
<h4 style="margin-left:.25in;text-align:justify;text-indent:
-.25in;mso-list:l5 level1 lfo4;tab-stops:list .25in"><!--mstheme--><font color="#003366"><font face="Verdana">1. Patient
referral</font><!--mstheme--></font></h4>
<p class="MsoNormal" style="text-align:justify"><font face="Verdana">The majority of
partner notification in the UK is patient referral based. The preferred method of
patient referral is through the use of <a href="../professional_interest/slips">contact slips</a>. These
enable reliable and efficient cross-referencing and ensure appropriate screening and
treatment of the contact. The use of Department of Health diagnostic codes for STDs
on contact slips provides an anonymity and confidentiality for the index patient.
All health advisers should be conversant with Department of Health diagnostic codes for
STDs. Health advisers are the key health care professionals involved in patient
referral partner notification – other health care workers, e.g. doctors, may
instigate patient referral partner notification with the issue of contact slips.</font></p>
<p class="MsoNormal" style="text-align:justify"><font face="Verdana"> <o:p>All patients
with an STD should have partner notification issues raised with them. Patient
referrals relies on the use of contact slips and the co-operation of the patient/client.
Contact slips are issued in order to:-</font></p>
<p class="MsoNormal" style="text-align:justify"><font face="Verdana"> a)
enable sexual contacts to seek medical advice and treatment</font></p>
<p class="MsoNormal" style="margin-left:.5in;text-align:justify;text-indent:-.5in;
mso-list:l2 level1 lfo5;tab-stops:list .5in"><font face="Verdana">b) to inform the contacts clinic of index patients
diagnosis, reference number and date of diagnosis.</font></p>
<p class="MsoNormal" style="margin-left:.5in;text-align:justify;text-indent:-.5in;
mso-list:l2 level1 lfo5;tab-stops:list .5in"><font face="Verdana">c) to cross reference and enable evaluation of
partner notification action.</font></p>
<h4 style="margin-left:.5in;text-align:justify"><!--mstheme--><font color="#003366"><font face="Verdana">The issue of contact slips should include
the following considerations:</font><!--mstheme--></font></h4>
<p class="MsoNormal" style="text-align:justify"><font face="Verdana"> <o:p></o:p>i)
One contact slip for each contact</font></p>
<p class="MsoNormal" style="margin-left:.5in;text-align:justify;text-indent:-.5in;
mso-list:l1 level1 lfo6;tab-stops:list .5in"><font face="Verdana">ii) Each contact slip with contain the following
information relating to the index patient; date of diagnosis, reference number; Department
of Health diagnostic code; name and address of issuing clinic. The reverse of the
contact slip ship should be completed with the contacts information, reference number;
date of attendance, Department of Health diagnostic code and name and address of issuing
clinic. If contacts attend other GUM, completed contact slips should be returned to
the issuing clinic as soon as possible.</font></p>
<p class="MsoNormal" style="margin-left:.5in;text-align:justify;text-indent:-.5in;
mso-list:l1 level1 lfo6;tab-stops:list .5in"><font face="Verdana">iii) All information from contact slips should be
cross-referenced.</font></p>
<p class="MsoNormal" style="text-align:justify"><font face="Verdana">Patient referral
partner notification may take place without the issuing of contact slips, for example,
when the contact is only accessible by telephone or lives abroad (Department of Health
diagnostic codes are not applicable outside the UK). World Health Organisation codes
are available but, as these may not be widely used, naming the infection may be
preferable.</font></p>
<p class="MsoNormal" style="text-align:justify"><font face="Verdana">Patients should be
encouraged to use contact slips as this helps facilitate the management of partner
notification.</font></p>
<h4 style="margin-left:.25in;text-align:justify;text-indent:
-.25in;mso-list:l5 level1 lfo4;tab-stops:list .25in"><!--mstheme--><font color="#003366"><font face="Verdana">2. Provider
referral</font><!--mstheme--></font></h4>
<p class="MsoNormal" style="margin-left:.25in;text-align:justify"><font face="Verdana">This
is where the index patient decides that they wish the health adviser to manage partner
notification on their behalf.</font></p>
<p class="MsoNormal" style="margin-left:.25in;text-align:justify"><font face="Verdana">To
enable the health adviser to carry out provider referral the index patient must give full
and accurate information regarding contact(s) sought. Provider referral should be
offered by health advisers to those patients where other methods of partner notification
are inappropriate.</font></p>
<p class="MsoNormal" style="margin-left:.25in;text-align:justify"><font face="Verdana">As
with all forms of partner notification the <a href="#Confidentiality">confidentiality</a>
of the index case must be protected, although it is important that possible loss of
confidentiality is discussed with the index patient before any provider referral is
commenced. Identification of the index patient must never be confirmed by a health
adviser. However, if the contact has only one sexual partner, confidentiality may be
compromised.</font></p>
<p class="MsoNormal" style="margin-left:.25in;text-align:justify"><font face="Verdana">It
may be necessary for the health adviser to seek the assistance of colleagues in other
clinics in order to carry out provider referral.</font></p>
<p class="MsoNormal" style="margin-left:.25in;text-align:justify"><font face="Verdana">Provider
referral may take place by letter, telephone call or domiciliary visit.</font></p>
<h4 style="margin-left:.25in;text-align:justify"><!--mstheme--><font color="#003366"><font face="Verdana">Methods</font><!--mstheme--></font></h4>
<!--mstheme--></font><!--msthemelist--><table border="0" cellpadding="0" cellspacing="0" width="100%">
<!--msthemelist--><tr><td valign="baseline" width="42"><img src="../_themes/shastd2/shasbul3.gif" width="35" height="24" hspace="3" alt="bullet"></td><td valign="top" width="100%"><!--mstheme--><font face="verdana, Arial, Helvetica"><p class="MsoNormal" style="text-align:justify"><font face="Verdana">Letter</font></p>
<!--mstheme--></font><!--msthemelist--></td></tr>
<!--msthemelist--></table><!--mstheme--><font face="verdana, Arial, Helvetica">
<p class="MsoNormal" style="text-align:justify"><font face="Verdana">There should be nothing specific in the
letter to suggest STDs. The envelope should be marked “<strong>Private and
Confidential – Addressee Only</strong>” and the envelope should not be
identifiable as being sent from a hospital. The full name and address provided the
index patient should be used. It is sometimes possible to check addresses through
the telephone directory, FHSA and electoral roles. A telephone number for easy
access to a health adviser needs to be included in the letter in order to encourage swift
resolution of partner notification.</font></p>
<!--mstheme--></font><!--msthemelist--><table border="0" cellpadding="0" cellspacing="0" width="100%">
<!--msthemelist--><tr><td valign="baseline" width="42"><img src="../_themes/shastd2/shasbul3.gif" width="35" height="24" hspace="3" alt="bullet"></td><td valign="top" width="100%"><!--mstheme--><font face="verdana, Arial, Helvetica"><p class="MsoNormal" style="text-align:justify"><font face="Verdana">Telephone</font></p>
<!--mstheme--></font><!--msthemelist--></td></tr>
<!--msthemelist--></table><!--mstheme--><font face="verdana, Arial, Helvetica">
<p class="MsoNormal" style="text-align:justify"><font face="Verdana">The correct identify of the patient
contact needs to be established by the health adviser. Issues to be taken into
account include: convenient time for discussion of a personal nature and possible need for
verification of the authenticity of the call. Checking correct identity over the
phone is difficult, therefore one should disclose as little as possible and encourage a
face to face interview.</font></p>
<!--mstheme--></font><!--msthemelist--><table border="0" cellpadding="0" cellspacing="0" width="100%">
<!--msthemelist--><tr><td valign="baseline" width="42"><img src="../_themes/shastd2/shasbul3.gif" width="35" height="24" hspace="3" alt="bullet"></td><td valign="top" width="100%"><!--mstheme--><font face="verdana, Arial, Helvetica"><p class="MsoNormal" style="text-align:justify"><font face="Verdana"> Domiciliary Visit</font></p>
<!--mstheme--></font><!--msthemelist--></td></tr>
<!--msthemelist--></table><!--mstheme--><font face="verdana, Arial, Helvetica">
<p class="MsoNormal" style="text-align:justify"><font face="Verdana">The advantages and disadvantages of each
individual domiciliary visit need to be carefully considered prior to undertaking this
method of partner notification. Visits risk causing domestic upset to the
partner/contact if other family members/friends or partners are present, but allow for the
contact to be informed of their potential exposure and to be reassured. As with all
domiciliary visits the safety of staff is of paramount importance.</font></p>
<h4 style="text-align:justify"><!--mstheme--><font color="#003366"><font face="Verdana"> <o:p></o:p>3.
Contract Referral</font><!--mstheme--></font></h4>
<p class="MsoNormal" style="margin-left:.25in;text-align:justify"><font face="Verdana">This
is a method where the patient and health adviser negotiate and agree with an acceptable
time span in which the index patient will attempt patient referral. If this is not
successful then re-negotiation takes place and provide referral may be agreed.</font></p>
<p class="MsoNormal" style="margin-left:.25in;text-align:justify"><font face="Verdana">The
preferred method for patient referrals is through the use of contact slips. They
enable reliable and efficient cross referencing and ensure appropriate screening and
treatment of the contact.</font></p>
<h4 style="margin-left:.25in;text-align:justify;text-indent:
-.25in;mso-list:l5 level1 lfo4;tab-stops:list .25in"><!--mstheme--><font color="#003366"><font face="Verdana">4. No
Referral</font><!--mstheme--></font></h4>
<p class="MsoNormal" style="margin-left:.25in;text-align:justify"><font face="Verdana">There
will be situations when no method of partner notification is appropriate. This may
be where there is a threat of physical violence, either to the patient or to the health
advisers; or where there is a history of sexual assault; or if the partner notification
has to take place abroad; or if there is insufficient information.</font></p>
<h3 style="margin-left:.25in;text-align:justify"><!--mstheme--><font color="#003366"><a name="Issues for Consideration in the Management of Partner Notification"><font face="Verdana">Issues for Consideration in the Management of Partner Notification</font></a><!--mstheme--></font></h3>
<!--mstheme--></font><!--msthemelist--><table border="0" cellpadding="0" cellspacing="0" width="100%">
<!--msthemelist--><tr><td valign="baseline" width="42"><img src="../_themes/shastd2/shasbul3.gif" width="35" height="24" hspace="3" alt="bullet"></td><td valign="top" width="100%"><!--mstheme--><font face="verdana, Arial, Helvetica"><p class="MsoNormal" style="margin-left:.5in;text-align:justify;text-indent:-.25in;
mso-list:l0 level1 lfo7;tab-stops:list .5in"><font face="Verdana">Partner notification must take into account both current and ex-partners,
as is appropriate to the aetiology of the infection. The amount of time and effort
spent on partner notification will depend on the diagnosis, the probable duration of
infection, individual patient factors, and resources.</font></p>
<!--mstheme--></font><!--msthemelist--></td></tr>
<!--msthemelist--><tr><td valign="baseline" width="42"><img src="../_themes/shastd2/shasbul3.gif" width="35" height="24" hspace="3" alt="bullet"></td><td valign="top" width="100%"><!--mstheme--><font face="verdana, Arial, Helvetica"><p class="MsoNormal" style="margin-left:.5in;text-align:justify;text-indent:-.25in;
mso-list:l0 level1 lfo7;tab-stops:list .5in"><font face="Verdana">There may be situations when it is impossible and/or inappropriate to
instigate partner notification. Health advisers must document the reasons for not
notifying partners.</font></p>
<!--mstheme--></font><!--msthemelist--></td></tr>
<!--msthemelist--><tr><td valign="baseline" width="42"><img src="../_themes/shastd2/shasbul3.gif" width="35" height="24" hspace="3" alt="bullet"></td><td valign="top" width="100%"><!--mstheme--><font face="verdana, Arial, Helvetica"><p class="MsoNormal" style="margin-left:.5in;text-align:justify;text-indent:-.25in;
mso-list:l0 level1 lfo7;tab-stops:list .5in"><font face="Verdana">Health advisers need confidential, soundproofed rooms to see patients for
partner notification. It is important for private, uninterrupted consultation to
take place in order to facilitate this process.</font></p>
<!--mstheme--></font><!--msthemelist--></td></tr>
<!--msthemelist--><tr><td valign="baseline" width="42"><img src="../_themes/shastd2/shasbul3.gif" width="35" height="24" hspace="3" alt="bullet"></td><td valign="top" width="100%"><!--mstheme--><font face="verdana, Arial, Helvetica"><p class="MsoNormal" style="margin-left:.5in;text-align:justify;text-indent:-.25in;
mso-list:l0 level1 lfo7;tab-stops:list .5in"><font face="Verdana">Health advisers involved in partner notification should have adequate <a href="../professional_interest/supervis">professional supervision</a> and support</font></p>
<!--mstheme--></font><!--msthemelist--></td></tr>
<!--msthemelist--><tr><td valign="baseline" width="42"><img src="../_themes/shastd2/shasbul3.gif" width="35" height="24" hspace="3" alt="bullet"></td><td valign="top" width="100%"><!--mstheme--><font face="verdana, Arial, Helvetica"><p class="MsoNormal" style="margin-left:.5in;text-align:justify;text-indent:-.25in;
mso-list:l0 level1 lfo7;tab-stops:list .5in"><font face="Verdana">It is important that the network of health advisers throughout the United
Kingdom is utilised and strengthened and that information sharing between clinics is
encouraged.</font></p>
<!--mstheme--></font><!--msthemelist--></td></tr>
<!--msthemelist--><tr><td valign="baseline" width="42"><img src="../_themes/shastd2/shasbul3.gif" width="35" height="24" hspace="3" alt="bullet"></td><td valign="top" width="100%"><!--mstheme--><font face="verdana, Arial, Helvetica"><p class="MsoNormal" style="margin-left:.5in;text-align:justify;text-indent:-.25in;
mso-list:l0 level1 lfo7;tab-stops:list .5in"><font face="Verdana">All health advisers should be actively encouraged to attend the National
Health Advising Training courses that are available. In addition to this, health
advisers should be supported in their professional development by management and the team
within which they work. Health advisers should take responsibility for their
professional development and the updating and enhancing of skills and knowledge.</font></p>
<!--mstheme--></font><!--msthemelist--></td></tr>
<!--msthemelist--><tr><td valign="baseline" width="42"><img src="../_themes/shastd2/shasbul3.gif" width="35" height="24" hspace="3" alt="bullet"></td><td valign="top" width="100%"><!--mstheme--><font face="verdana, Arial, Helvetica"><p class="MsoNormal" style="margin-left:.5in;text-align:justify;text-indent:-.25in;
mso-list:l0 level1 lfo7;tab-stops:list .5in"><font face="Verdana">The safety of health advisers, as with all health care workers, should be
of paramount importance.</font></p>
<!--mstheme--></font><!--msthemelist--></td></tr>
<!--msthemelist--><tr><td valign="baseline" width="42"><img src="../_themes/shastd2/shasbul3.gif" width="35" height="24" hspace="3" alt="bullet"></td><td valign="top" width="100%"><!--mstheme--><font face="verdana, Arial, Helvetica"><p class="MsoNormal" style="margin-left:.5in;text-align:justify;text-indent:-.25in;
mso-list:l0 level1 lfo7;tab-stops:list .5in"><font face="Verdana">Documentation should be accurate and complete, to enable regular audits to
take place.</font></p>
<!--mstheme--></font><!--msthemelist--></td></tr>
<!--msthemelist--><tr><td valign="baseline" width="42"><img src="../_themes/shastd2/shasbul3.gif" width="35" height="24" hspace="3" alt="bullet"></td><td valign="top" width="100%"><!--mstheme--><font face="verdana, Arial, Helvetica"><p class="MsoNormal" style="margin-left:.5in;text-align:justify;text-indent:-.25in;
mso-list:l0 level1 lfo7;tab-stops:list .5in"><font face="Verdana">The rights of the index patient and their partner/contact must be
respected.</font></p>
<!--mstheme--></font><!--msthemelist--></td></tr>
<!--msthemelist--><tr><td valign="baseline" width="42"><img src="../_themes/shastd2/shasbul3.gif" width="35" height="24" hspace="3" alt="bullet"></td><td valign="top" width="100%"><!--mstheme--><font face="verdana, Arial, Helvetica"><p class="MsoNormal" style="margin-left:.5in;text-align:justify;text-indent:-.25in;
mso-list:l0 level1 lfo7;tab-stops:list .5in"><font face="Verdana">Partner notification can be complicated further by issues of sexuality.
The health advisers should be aware of the need for sensitivity in relation to
issues of sex and sexuality.</font></p>
<!--mstheme--></font><!--msthemelist--></td></tr>
<!--msthemelist--><tr><td valign="baseline" width="42"><img src="../_themes/shastd2/shasbul3.gif" width="35" height="24" hspace="3" alt="bullet"></td><td valign="top" width="100%"><!--mstheme--><font face="verdana, Arial, Helvetica"><p class="MsoNormal" style="margin-left:.5in;text-align:justify;text-indent:-.25in;
mso-list:l0 level1 lfo7;tab-stops:list .5in"><font face="Verdana">Health advisers are responsible for managing the processes and outcomes of
partner notification. However, within the multidisciplinary setting, it may be
appropriate for doctors and nurses to raise some of these issues.</font></p>
<!--mstheme--></font><!--msthemelist--></td></tr>
<!--msthemelist--></table><!--mstheme--><font face="verdana, Arial, Helvetica">
<p class="MsoNormal" style="text-align:justify"><strong><small><font face="Verdana">It is hoped that these
guidelines will facilitate partner notification and encourage good practice and
management. In addition it is hoped that those clinics that do not have a written
policy for partner notification will use these guidelines as a basis from which to work.</font></small></strong></p>
<p class="MsoNormal" style="text-align:justify"><a href="../professional_interest/partner"></a></p>
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