Notifying partners of patients with early syphilis in Madagascar: case-finding effectiveness and public health implications.
OBJECTIVE
To evaluate the case-finding effectiveness of a clinic-based partner notification effort for early syphilis in Madagascar.


METHODS
We asked index cases who had proven early syphilis to identify and provide contact information of recent sex partners (in the past 3, 6, and 12 months for primary, secondary, and early latent syphilis, respectively). Named sex partners were contacted by index cases (patient notification) or, if approved by the index case, clinic staff members (provider notification); notified of their potential exposure to syphilis; and asked to come to the clinic for evaluation. We assessed case-finding effectiveness and calculated the 'brought-to-treatment' index (number of newly-diagnosed syphilis cases per number of index cases interviewed).


RESULTS
Of 565 index cases, 534 reported recent sex with at least one sex partner. A total of 3167 sex partners were reported, of whom 276 were contactable (9% of 3167). Providers notified 76% and cases notified 24% of these partners. 270 partners were contacted (98% of 276), and of these, 199 presented to the clinic for evaluation (74% of 270). A total of 99 partners tested positive for syphilis and received treatment (50% of 199). The 'brought-to-treatment' index was 0.18 (99 diagnoses per 565 index cases).


CONCLUSIONS
Partner notification was possible in this setting, resulting in treatment of syphilis-infected individuals who otherwise would likely have remained untreated. However, given <10% of the partners reported by index cases were contactable; the results highlight the limitations of partner notification and the need for additional sexually transmitted infection control strategies.
Khan
Maria R
MR
Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, USA. mrkhan@umd.edu
Ravelomanana
Noro
N
Van Damme
Kathleen
K
Randrianasolo
Bodo S
BS
Ramaniraka
Verolanto
V
Ranaivo
Naina
N
Ratsiambakaina
Diana
D
Cohen
Myron
M
Behets
Frieda
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016358:Contact Tracing / Q000379:methods*; D005260:Female; D006801:Humans; D008270:Madagascar / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011634:Public Health; D012725:Sexual Behavior; D012747:Sexual Partners; D012749:Sexually Transmitted Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D013587:Syphilis / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult