Effectiveness of self-referral for male patients with urethral discharge attending a sexually transmitted disease clinic in China

Background: Although partner notification (PN) has long been considered as an important component in sexually transmitted disease (STD) control programs and has been implemented in both developed and developing world, little information is known about the acceptability and efficacy of the strategy in China. Goal: The goal of this study was to assess the acceptability and outcome of self-referral for male patients with urethral discharge and to identify the characteristics associated with successful outcome based on a specialized STD clinic. Methods: From November 2001 to November 2002, 730 patients with confirmed urethral discharge were selected and asked by STD clinicians to bring their sexual contacts to treatment in a specialized STD clinic. The demographic and sexual characteristics of returned and unreturned index patients were analyzed. Univariate and multi-variate analyses were applied to identify the characteristics associated with the outcome of self-referral. Results: Of 723 eligible index patients, 294 (40.7%) who returned for follow up identified 534 sexual partners and 429 (59.3%) who did not return for follow up identified 759 sexual partners. Of the total named 1293 sexual partners, 301 (23.3%) were notified by index male patients and 265 (20.5%) presented at the clinic. Of the 265 partners tested, 165 (62.3%) were infected with gonorrhea, chlamydia, or both; of them, 78 (47.3%) were asymptomatic. When the partnerships were married and steady, the informed rate was higher than that when the partnership was casual. For commercial sexual partnerships, only 1.8% of the partners were informed. In multivariate analysis, a prior STD history and condom use during the last sexual contact were associated with successful outcome of notification. Conclusion: Patient referral was accepted both by STD clinic attendees and STD clinicians. The results of the study show that use of self-referral for partners of men with urethral discharge in a Chinese STD clinic was, with minimal effort, moderately successful. Further efforts to improve case-finding outcomes are warranted.