Partner notification for syphilis: a randomized, controlled trial of three approaches.

OBJECTIVE To determine the cost and effectiveness of three approaches to partner notification for infectious syphilis. STUDY DESIGN People with syphilis were randomly assigned to: (1) notification of partners by patients themselves within 2 days or disease intervention specialists would notify them; (2) immediate notification by intervention specialist; or (3) immediate notification by intervention specialists, who had the option of drawing blood in the field. Costs of intervention specialists' time, travel, and overhead were measured. Intention-to-treat analysis measured outcomes per randomized index patient. RESULTS From December, 1990 through March, 1993, 1,966 index patients with syphilis (primary 9%; secondary 18%; and early latent 73%) were randomized in Broward County (Ft. Lauderdale), Florida (1,191); Tampa, Florida (569); and Paterson, New Jersey (206). Index patients reported 11,272 potentially exposed partners and sufficient information to initiate investigations for 2,761. Of these, 2,236 were located, 367 had newly identified infections, and 870 others received preventive treatment. The three partner notification approaches had similar success locating partners (1.1-1.2 per index patient) and treating partners (0.61-0.67 per index). The cost was $317 to $362 per partner treated; the optimal strategy differed by study site. CONCLUSIONS Partner notification identified many infected and potentially infected people. The cost and effectiveness of the three types of provider notification were similar. Alternative approaches are needed to reach infected partners who could not be notified.