Evaluating a new partner management strategy for bacterial sexually transmitted infections after a change in 2020 in Amsterdam, the Netherlands, 2017 to 2023

BACKGROUNDFrom 1 March 2020, the Centre for Sexual Health Amsterdam limits presumptive treatment for chlamydia or gonorrhoea to clients notified by steady partners. Treatment after notification by non-steady partners requires a positive test result.AIMWe aimed to evaluate this change in policy on unnecessary antibiotic treatment, time to treatment and lost to follow-up clients.METHODSWe included consultations (with testing) following partner notification for chlamydia or gonorrhoea between 1 March 2017 and 1 March 2023. Primary outcome was unnecessary antibiotic treatment (presumptive treatment with negative test result) before vs after the policy change. We also assessed return for treatment of confirmed and not presumptively treated individuals after the policy change.RESULTSFrom 4,579 consultations, unnecessary antibiotics were prescribed for 786/1,318 (59.6%) clients for chlamydia and 729/1,117 (65.3%) clients for gonorrhoea before 1 March 2020. After 1 March 2020, this decreased to 324/1,275 (25%) and 341/1,369 (25%), respectively, corresponding to a relative reduction of 58% for chlamydia (adjusted relative risk (aRR): 0.42; 95% confidence interval (CI): 0.37-0.47) and 63% (aRR: 0.37; 95% CI: 0.33-0.42) for gonorrhoea. After the policy change, clients not given presumptive treatment but later diagnosed returned after a median of 7 days (interquartile range (IQR): 5-8) for chlamydia and 6 days (IQR: 4-7) for gonorrhoea. Missed treatment occurred in 4/155 (2.6%) of chlamydia and 5/158 (3.2%) of gonorrhoea consultations.CONCLUSIONThe new partner management protocol substantially reduced unnecessary antibiotic treatment for chlamydia and gonorrhoea. The majority of confirmed infections still received appropriate treatment.