The ethical issues surrounding STDs havc to do l’ith partner notification, contact tracing, and reporting requirements. Although reporting requirernents vary somewhat fron-t state t0 state, certain diseases are reportable nationally such as syphilis, gonorrhea, and AIDS. Herpes simplex is generally not reportable and there is no contact tracing for herpes. Contact tracing is predominantly used to intcrrupt a cyclc of transmission. Herpes cannot be eradicated from the body; hence there is no utility in treating the partner. Gonorrhea and s,vphilis, however, can be asymptomatically carried try the contacts of our patients and they can be transmitted to additional partners even if the source patient is asymptomatic. In addition, syphilis and gonorrhea can be eradicated (cured) with treatment.
For exomple,‘tsob’ is a 32-year-old man in your clinic being treated for primary syphilis. He is very embarrassed about his diagnosis and he asks you if his condition rvill be kept confidential. Wliat should you tell him?
Just because,vou must contact and treat partners of patients rsith STDs such as syphilis does not mean you will breach his confidentiality and identit| him as the source to lris contacts. l here is a clear order oftracing and treating his sexuaL contacts. Ifthere is a choice that says “encourage him to notif. his partners” or “ask if he has already told his contacts” that should be the first thing 1o clo. If that is not a choice, then you should ofler to inform the contacts for the patient if he does Dot want to do it. At all points you should be clear that ,vou wiJl not contact his partners and say, “llob gave you a disease.”
For example, Bob tells you that he is rot confortable informing his partners himself and he does not want you to clo it either. What should you tell him?
The Department of Health car.r compile a list of contacts of patients with STDs and notifi the contacts that they are at risk. The Department of Health does not dir.r"rlge Bob’s name to the contact. The Department of Health contacts the partners and says there is an important health issue concerning them that has come to the department’s attention and then asks them to come to the hcalth departrnent. \4ren they arrive, the partners are told for which disease they are at risk, but they are r.rot told the identity ofthe source. The1. n1. 1h.n encouraged to seek testing and treatment. The najority of patierts r^/ish to be inforned, tested, and treated in order to protect their own health.
For example, Bob does not want to tell eithcr you or the Department of Health the names of his partners. He says he is mor.rogamous now and, in fact, he is accon.rpanied by his pregnant wife. He has not told his wife ofhis condition. What should vou do now?
As always, you should answer “encouragc him to disclose,” “offer counseling for partner notification,” or some statement that is gentle in terms of respecting the patient’s autonomy. If these are not in the choices or the patient refuses then you nust directly notif. his pregnant wife immediately. Her testing and treatment is essential to protect both her own health as well as to prevent perinatal transmission. Congenital syphilis is a serious and dangerous disease but is entirely preventable.
For example, you politely inform Bob that you have a duty to protect both his rvife as well as his child and you are forced to noti$. her or have the l)epartment of Health noti$. her of her risk of syphilis if he will not do it. Ilob becomes furious and threatens to sue you if you violate his confidentiality. What should you tell him?
You are legally protected if you inform a person at risk of harm. ln addition, there is a duty to warn people at risk of harnr. Bob can get as upset as he wants. You are not legall,v at risk.