Do individuals have either (or both) a moral or a legal responsibility to inform sexual partners of a sexually transmitted disease? In this issue, Dunham et al1 addresses the issue by surveying health care workers (HCW) to determine if they believe the Centers for Disease Control and Prevention (CDC) has recommended informing sexual partners of an individual's hepatitis C (HCV) infection status. Although 73% of respondents believed that such guidelines exist, that belief is in error. The CDC has not addressed notifying sexual partners of individuals' HCV status. Eighty percent of respondents believe that guidelines recommending notification should be developed. Interestingly, shortly after the data for this study were obtained, the US Preventative Service Task Force released new guidelines recommending that every adult be tested at least once for hepatitis C except in extremely low-prevalence areas.
Intravenous drug abuse is the principal method of HCV infection: sexual transmission accounts for ~5% of cases.1 Resources for sexual contact tracing of HCV-infected individuals are better used for following through on cases of HIV, syphilis, gonorrhea, and chlamydia, which are more commonly transmitted sexually. Thus, partner notification could be an important modality for reducing sexual transmission of HCV. Although the survey did ask about recommending that a patient with HCV inform his or her partner of his or her status and recommend testing, the specific data from that question are not included in the report.
Above and beyond the overall guidelines, the survey found that less than half (44%) of the respondents said they always ask if the patient's sexual partner has been tested for HCV, although an additional 42% said they sometimes ask that question. In a similar vein, 42% said they always recommend that the partner of a patient with HCV be tested for HCV, and 44% said they sometimes make that recommendation for testing. Thus, in addition to the lack of guidelines for notifying sexual partners, there are also inconsistencies among HCW to make that recommendation.
One area not included in the survey was the HCW's opinions of the HCV screening test's accuracy; in other words, does the HCW have sufficient confidence in the test results to recommend testing? The CDC has stated that biologic false-positive results are unlikely when multiple tests are used on a single specimen. The current CDC HCV testing recommendation that a current generation enzyme-linked immunosorbent assay/chemiluminescence/rapid HCV antibody test be followed by an HCV nucleic acid test fulfills that statement.2
Finally, the pamphlet/information sheet proposed by Dunham et al1 should improve the number of HCW recommendations for sexual partner notification and testing. An HCW can hand out the pamphlet whether or not they would make the specific partner testing recommendation to the patient. I could see adding a statement in the pamphlet or providing a separate pamphlet mentioning that patients should inform their intravenous drug use partners about their status. Regulatory, ethical, and legal issues aside, recommending partner notification is good medical practice.
1. Dunham K, McDonald J, Yousaf A, et al. Healthcare providers' views on hepatitis C testing and counseling among sexual partners of hepatitis-C–infected persons: an online survey. Inf Disease in Clin Practice
2. Centers for Disease Control and Prevention (CDC). Testing for HCV infection: an update of guidance for clinicians and laboratorians. MMWR Morb Mortal Wkly Rep
. 2013;62(18):362–365. PMID: 23657112.