Public Health Ethics: Case 1
Sexually Transmitted Diseases and Contact Tracing
MG is a 27-year-old graduate student, recently married, who comes into the student health clinic for a routine pelvic exam and Pap smear. During the course of the exam, the gynecology resident performing the exam obtains the Pap smear, but also obtains cervical cultures for gonorrhea and chlamydia. The examination concludes uneventfully.
Several weeks later, MG receives a postcard indicating that the Pap smear was normal, with no evidence of dysplasia, but that the cervical culture for gonorrhea was positive. The card instructs her to come into the clinic to discuss treatment, and that "public health authorities" have been notified for contact tracing, which refers to the identification and diagnosis of sexual partners, as required by law. The young woman is terrified that her husband will be contacted.
Is contact tracing ethically justified?
Yes. Her sexual partners have a right to know that they were exposed to gonorrhea. Notification has positive public health benefits that outweigh the young woman’s concerns about violation of privacy. First, those notified can be tested and treated. Second, they can take precautions to protect others from contracting gonorrhea (like using condoms). Third, their sexual partners can be notified to further reduce the spread of infection. To address the young woman’s concerns, she can seek advice from her doctor and public health officials and may choose to tell her husband herself. Should she fail to inform her husband, public health officials will be obligated to do so.