Partner notification is an essential public health intervention for the control of STIs. Ideally, when patients are diagnosed with an STI, their sexual partners are notified of exposure as well as invited for testing and, if necessary, treatment. Partner notification helps to ensure that affected individuals get treatment and also helps to reduce the further spread of STIs. Partner notification is an important practice for all STIs, but it may be critical for diseases that are frequently asymptomatic, such as Chlamydia, and for high-risk populations.
Partner notification can be challenging. Patients may be afraid or embarrassed to pass on information to intimate partners while public health agencies may lack the resources to identify and contact all those exposed to an STI. But partner notification becomes especially difficult when intimate partners are anonymous, unknown to each other.
For example, sexual partners who meet through the internet may be identified only by an email address or an on-line “handle” (electronic name). Similarly, casual or one-time sexual partners may not exchange names and contact information. As a result, it may not be easy or even possible to identify and locate anonymous partners.
Historically, men who have sex with men (MSM) have been the population with the highest numbers of anonymous partners.
In one study of partner notification for syphilis among MSM, the prevalence of anonymous sex ranged from 45 per cent to 88 per cent in eight American cities. But anonymous sex is not confined to MSM. It is also common in the general population, with as much as 60 per cent of those with STIs reporting that they have ever had an anonymous partner. At the same time, research suggests that rates of reinfection are highest among individuals with multiple partners and anonymous partners. The prevalence and potential public health impact of anonymous sex make it imperative to find ways of contacting anonymous partners.
Traditional approaches to patient notification—in-person conversations, the telephone, and mail—have been shown to increase rates of diagnosis and treatment and reduce risky behaviours. While these methods are not possible with anonymous partners, new technologies, specifically the internet, email, and text messaging, may improve the chances of notifying anonymous partners of STI exposure. Internet partner notification (IPN) seems to be accepted by many patients. For example, one American study found that 92 per cent of MSM using sex-partner websites were also prepared to use the internet to notify partners of STIs. Other research demonstrates consistent support for partner notification by email, both in the general population and among MSM.
Text messaging appears to be a less popular alternative, though it is more likely to be accepted by males under the age of 25 who have access to a mobile phone and higher education. The use of technology for APN has to be approached with some caution. Websites, blogs and internet forums may not welcome partner notification efforts, particularly when these are undertaken by public health agencies rather than members. In some cases, these agencies have resorted to creating fictitious profiles to carry out partner notification through the internet.
Further, reports of the effectiveness of the internet, email and text messaging for patient notification vary widely—from 26 per cent to 80 per cent. For example, two partner notification websites, InSpot and Let Them Know, have been set up and adopted in several countries, but initial high rates of use have not been sustained. It is also not known how much these sites have contributed to increased testing and treatment or reductions in risky behaviour.
More research on the effectiveness and cost-effectiveness of electronic notification of STIs with anonymous partners is needed. Yet if we accept even the lowest reported success rates, IPN is still better than no notification at all, which would have been the case with many anonymous partners in the pre-internet era.
Successful partner notification is a key element of STI control efforts and notification of anonymous partners is a pressing problem for public health agencies. Partner notification through the internet, email, and texting is currently the most promising approach to APN.