Steps in Contact Tracing
All contact tracing should be undertaken whilst respecting the individual patient's sensitivities and needs, and should not result in harm. The approach in contact tracing may vary depending on the population involved. You can go to the Special Populations section for additional help.
STEP 1. Introduce the reasons for contact tracing
Patients should be informed about:
• Asymptomatic infection. Sexual contacts that are infected are usually asymptomatic and unaware of their infection.
• Possible serious complications for partners if partners are not tested and treated.
• Risk of reinfection where relevant
STEP 2. Help identify who needs to be notified
• Discuss mode of transmission and likely duration of infection.
• Trace back contacts from the relevant time periods for the particular STI
Table 1 summarises how far back in time patients should be advised to contact partners. These are also shown for each individual in Conditions.
When taking a sexual history for the purposes of optimising contact tracing, a good starting place is the chronology of sex. For example, ask ‘When did you last have sex?’ and ‘When did you have it with a different person?’ Then ask what happened with each partner for example; ‘Did you use condoms with this person?’ or ‘Did you share needles with this person?’ Once one has a sense of the number of recent partners, further enquiry can be made about the nature of those partners – whether they were regular, casual, or whether this occurred overseas, etc. During discussion of partners, the health care provider and the patient can discuss whether contacts are likely to be contactable and how the patient feels about contacting them.
When taking the history:
• It may not be necessary to exhaustively enquire about every detail for every partner; however, in the case of more serious infections, for example HIV, a more detailed partner history is warranted.
• Index patient may have had casual or anonymous partners and not know their identities or contact details.
• More detailed enquiry might include explicit information about the relationship with contacts, specific sexual practices, condom use and physical location, for example, brothel, gay sauna, overseas. In the case of blood-borne infections, ask about blood donation, receipt of blood products, and sharps exposure.
STEP 3. Explain the methods and offer choice
• Contacts can be notified by Patient referral or Provider referral
• Work with the patient to decide the most appropriate method for each of their contacts
Patient versus Provider Referral
• The index patient personally notifies his or her contact.
• The health care provider provides the information to be imparted by the index patient to the partner.
• Individuals usually prefer to notify contacts personally
• Quicker and easier
• Less confidentiality
• Patients may not actually contact partners
• The health care provider directly advises the contact or uses another agency (for example, sexual health service, public health unit or health department contact tracer) to ensure that contacts are notified.
• The health care provider must have the explicit approval of the index patient.
• Higher level of confidentiality for the index patient
• Method of choice when an individual fears a violent reaction, and for certain situations and conditions (for example, pulmonary TB, transfusion-related infections, when contact will involve sex workers or person with intellectual disability)
• May be appropriate for serious infections such as HIV where rigorous case finding is warranted
• More time- and resource-intensive
STEP 4. Support, Contact and Refer
Support the patient with patient referral – provide resources and arrange follow up
telephone contacts as agreed with index or refer index or their contacts to a specialist service.