Tracing and treating contacts of gonorrhea patients in a clinic for sexually transmitted diseases.

Abstract

TRACING FEMALE CONTACTS of males with gonorrhea and giving them epidemiologic treatment-treatment based on exposure rather than proved infectionhas been the policy of the Center for Disease Control (CDC) since 1950. More recently, this policy was expanded to include male contacts of culture-positive females (1). State and local programs that bring contacts to treatment have been encouraged to include male contacts by CDC monies and a nationwide corps of public health advisors. Clinics that provide epidemiologic treatment for gonorrhea should give contacts an estimate of their risk of infection. To meet the demand of informed consent, the risk estimate should be current, sex specific, and pertain to a particular clinic's population. However, some difficult questions remain as to the cost effectiveness of contact tracing in the overall effort of gonorrhea control. To answer these questions, we devised a surveillance system for contact-tracing activities that enables a clinic for sexually transmitted diseases to monitor the risk of infection in male and female contacts of patients with gonorrhea, the contribution of gonorrhea identified through contact tracing to the total clinic gonorrhea caseload, and the relative cost effectiveness of two methods of bringing contacts to treatment: CDC-trained investigators versus self-referral contact cards administered by a clinician.