GHENT UNIVERSITY Karoline FONCK - International Centre for ...

studies, indicating that couples are more accepting and compliant with partner treatment
recommendations when they are framed in the context of reproductive health (Desormeaux
1996, Jenniskens 1994). In Rwanda, pregnant women were more likely to refer partners than
non-pregnant women with an STD (33% vs. 20%) (Steen 1996). In an earlier study from
Kenya, 50% of partners of pregnant women with syphilis were treated in the same antenatal
clinic as the index patients (Jenniskens 1995). In Haiti, 41% of the partners of pregnant
women with STDs, were treated mainly as a result of index referral (Desormeaux 1996).
The referred partners are, with few exceptions, the regular partners of tile index case.
Others have also shown difficulties of tracing casual contacts, which may play an important
role in continued transmission (Steen 1996, Day 1998). Moreover, none of the women in our
Study referred more than one sexual partner for treatment despite the fact that 33% of RPR
seroreactive women admitted having had more than one sexual partner in the past year.
Women with syphilis are said to be more promiscuous than other STD patients as reported
by Andrus et al. who stated that patients who had syphilis had a larger number of sexual
encounters with persons who subsequently could not be identified unlike patients who had
gonorrhea. Unmarried women were also less likely to refer a sexual partner for treatment.
This suggests that more innovative methods and strategies are needed for reaching casual
partners.
There are several possible areas for improving partner referral. Improved counseling of index
patients is the most straightforward method. Educational messages at the community level
emphasizing the importance of partner treatment might also improve partner referral rates.
More innovative approaches are needed to identify the more epidemiologically important
casual partner. One strategy could be active tracing by specially trained staff (provider
referral) as opposed to notification by the index patient (patient referral) (Potterat 1991).
However, the logistics and cost of active tracing pose serious limitations to this approach,
and this is not only in resource-poor settings. In the UK, only 20 % of all sexual contacts of
patients with gonorrhea could be actively traced and subsequently screened (Bell 1998). A
combination of different methods might be helpful in further reducing the syphilis
seroprevalence that has been shown to decrease among pregnant women in Kenya
(Temmerman 1999).
All tracing programs however should take into account possible implications on the harmony
of the family. As shown in other studies, women who inform their spouse of having an STD
often face violence or even break-up of marriages or are blamed for bringing the disease to
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