are attempting to develop methods of protection that are not harmful to beneficial microbes and the lining of the lower reproductive tract (unlike nonoxynol-9) but are active against pathogenic organisms (IOM, 1996).

Partner Notification and Treatment

Partner notification has been a component of STD programs in the United States for many years (Rothenberg and Potterat, 1990). Championed by Surgeon General Thomas Parran at the first National Conference on Venereal Disease Control in 1936, it became an integral component of efforts against syphilis in this country after penicillin became widely available in the 1940s (Brandt, 1985). STD patient interviews followed by partner notification were considered to be the cornerstones of the early federal efforts against syphilis implemented by the Venereal Disease Branch at the National Communicable Disease Center, now known as the CDC. Partner notification has continued to be supported through current federally funded STD programs.

Because the incubation period for early syphilis is long (an average of three weeks, but anywhere from 10 to 90 days from exposure to onset of symptoms), partner notification could break the "chain of transmission" not only by identifying "source" cases of illness and partners with clinical or serologic evidence of disease, but also by identifying and treating partners exposed to syphilis. By providing treatment to exposed but asymptomatic partners, a potential case could be prevented by treatment of "incubating'' syphilis.

When the syphilis model was expanded to include the referral of partners exposed to gonorrhea (Potterat et al., 1989; Alary et al., 1991; CDC, DSTD/HIVP, 1992) and chlamydial infection (Katz et al., 1988; Alary et al., 1991), the rationale for partner notification had to be modified, since the incubation periods are shorter for gonorrhea (usually a week or less) and chlamydial infection (one to two weeks). Therefore, therapy of partners with incubating infections was not possible; instead, emphasis was placed on locating asymptomatic infected female partners of symptomatic men and on providing early treatment to prevent complications (CDC, DSTD/HIVP, 1992).

Identification of partners exposed to treatable bacterial STDs makes intuitive sense as an STD prevention strategy. "Source" cases—those exposing others to an STD—require treatment to break the chain of transmission. Partners who have been exposed to an already infected and infectious individual are at greatest risk for developing STD infection themselves. Treatment of infected or exposed partners will not only cure or prevent the infection (as in the case of incubating syphilis) but will both prevent STD transmission to future partners and directly benefit the exposed individual by preventing complications of untreated infection. Partner notification followed by partner treatment, therefore, is considered to be a strategy that benefits the individual index patient, his or her partner, and the community as a whole.



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