Hum. Reprod. Advance Access published online on January 9, 2009
Human Reproduction, doi:10.1093/humrep/den475
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Novel interventions to reduce re-infection in women with chlamydia: a randomized controlled trial
1 Department of Reproductive and Developmental Sciences, University of Edinburgh, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 5SU, UK 2 Dean Terrace Centre, 18 Dean Terrace Edinburgh, Edinburgh EH4 1NL, UK 3 Department of Genitourinary Medicine, Royal Infirmary of Edinburgh, Lauriston Building, Lauriston Place, Edinburgh EH3 9HA, UK 4 Department of Medical Microbiology, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 5SU, UK 5 Honorary Fellow, University of Edinburgh, UK
6 Correspondence address. Tel: +44-131-343-0912; Fax: +44-131-332-2931; E-mail: sharon.cameron{at}ed.ac.uk
BACKGROUND: The aim of this study was to determine whether postal testing kits (PTKs) or patient-delivered partner therapy (PDPT) for partners of women with Chlamydia trachomatis reduce re-infection rates in women, compared with partner notification by patient referral.
METHODS: Three hundred and thirty women testing positive for chlamydia, at clinics for genitourinary medicine, family planning and termination of pregnancy in Edinburgh, were randomized to one of three partner interventions: patient referral, PTK (partners post urine for testing) or PDPT (1 g azithromycin for partners). Women submitted urine for chlamydia testing every 3 months. The primary outcome was re-infection assessed as time to first positive result by the Cox proportional hazard regression. The proportion of partners tested or treated with each intervention was determined.
RESULTS: Out of 330 women, 215 (65%) were retested over 12 months. There were 32 of 215 women (15%) who retested positive (7, 15 and 10 women from the patient referral, PTK and PDPT groups, respectively). There was no significant difference in re-infection between PDPT versus patient referral (HR 1.32, 95% CI 0.50–3.56), PTK versus patient referral (HR 2.35, 95% CI 0.94–5.88) or PDPT versus PTK (HR 0.55, 95% CI 0.24–1.24). There was no significant difference in the proportion of partners confirmed tested/treated between the patient referral (34%) and PTK (41%, P = 0.32) or PDPT (42%, P = 0.28) groups.
CONCLUSIONS: PTK and PDPT do not reduce re-infection rates in women with chlamydia compared with patient referral. However, PDPT may offer other advantages such as simplicity and cost compared with patient referral.
Key words: Chlamydia trachomatis/patient-delivered partner therapy/partner notification/postal testing kits/re-infection
Submitted on October 9, 2008; resubmitted on November 20, 2008; accepted on December 5, 2008.