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Expedited Partner Therapy can it lower the numbers?

Posted Apr 28 2014 2:25pm

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  Expedited Partner Therapy (EPT) is the practice of treating sex partners of persons with STDs in the absence of medical evaluation or prevention counseling. Research shows that EPT is  effective in reducing STD rates.

Expedited Partner Therapy (EPT) a new clinical approach for chlamydia or gonorrhea

Expedited Partner Therapy (EPT) is the clinical practice of treating the sex partners of patients diagnosed with chlamydia or gonorrhea by providing prescriptions or medications to the patient to take to his/her partner without the health care provider first examining the partner, according to the CDC.

Chlamydia is the most commonly reported and treatable STDs in the United States. According to the 2010 Sexually Transmitted Diseases Surveillance report by the CDC, “STD are one of the most critical health challenges facing the nation today. CDC estimates that there are 19 million new infections every year in the United States.”

Over the last 20 years case reports of chlamydia have been regularly increasing. In 2010, 1.3 million chlamydia cases were reported. A majority of cases remain undiagnosed with only less than half of young women being screened. Reported rates were highest among women aged 18 years (4,700.5 cases per 100,000 females), aged 19 years (4,917.3 cases per 100,000 females), and aged 20 years (4,705.9 cases per 100,000 females). Rates among men were lower than women with the highest rates being in the ages 20–24 years (1,187.0 cases per 100,000 males).

In 2012, a total of 334,826 cases of gonorrhea were reported in the United States, these rates applied to both men and women. However, the rates for women have been slightly higher with an increase of 0.6%

The standard approach to partner treatment has included being clinically assessed in a healthcare setting and relied on the infected partner to notify partner (s).

Currently there are 35 states that allow physicians to legally provide antibiotic treatment for the sexual partners of their patients who have been diagnosed with chlamydia or gonorrhea, without having the partner come in to be examined. This approach is called expedited partner therapy or EPT.

The CDC concludes that EPT is a useful option to facilitate partner management, particularly for treatment of male partners of women with chlamydial infection or gonorrhea.

The American Academy of Family Physicians (AAFP) supports expedited partner therapy (EPT) according to the current Centers for Disease Control and Prevention (CDC) recommendations.

The American College of Obstetricians and Gynecologists (The College) in a new Committee Opinion issued a statement August 22, 2011, stating that they encourage Ob-gyns “to prescribe antibiotics for the male partners of their female patients diagnosed with chlamydia or gonorrhea to reduce the high reinfection rate.’

Dr. Diane F. Merritt, MD, hair of The College's Committee on Adolescent Health Care, commented "Evidence indicates that EPT can decrease reinfection rates compared to standard partner referrals for examination and treatment.”

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Research in EPT

A randomized controlled trial published in Clinical Infectious Diseases ( doi:10.1086/432476), set out to determine If patient-delivered partner treatment (PTDT) also called EPT was better than standard partner referral or booklet-enhanced partner referral (BEPR) in providing antibiotic treatment to sex partners of men with urethritis and in reducing recurrence of chlamydia or gonorrhea. The trial consisted of 977 men over the age of 24 years (51.6%) and African American (95%) and had ⩾2 partners (68.3%). All treatments were randomly assigned.

The researchers conclude PDPT was better than standard partner referral for treatment of partners and prevention of recurrence of C. trachomatisorN. gonorrhea infection.

In the journal BMC Infectious Diseases (doi:10.1186/1471-2334-10-274), Australian researchers sought to determine the views and practices of Australian general practitioners (GPs) in relation to partner notification and PDPT for chlamydia and explored GPs' perceptions of their patients' barriers to notifying partners of a chlamydia diagnosis.

Telephone interviews were conducted with 40 general practitioners (GPs). Topics covered: GPs' current practice and views about partner notification, perceived barriers and useful supports, previous use of and views regarding PDPT.

General practitioners reported “some partners do not seek medical treatment even after they are notified of being a sexual contact of a patient with chlamydia. More routine use of PDPT may help address this issue however GPs in this study had negative attitudes to the use of PDPT. Appropriate guidelines and legislation may make the use of PDPT more acceptable to Australian GPs.”

Benefits of EPT

According to the National Coalition of STD Directors Expedited Partner Therapy (EPT) works due to the following reasons:

EPT allows a healthcare provider to get treatment to a low-income or uninsured individual without a costly office visit or unduly taxing public health department staff.

Patients diagnosed with gonorrhea or chlamydia who received EPT were:

More likely to report that all of their sexual partners were treated than those who were told to refer their

Less likely to report having sex with an untreated partner; and partners for treatment;

Less likely to be diagnosed with another infection at a follow-up visit.

EPT is permissible in the following states:

Arkansas, California, Colorado, Connecticut. Hawaii, Idaho, Illinois, Indiana, Iowa, Louisiana, Maine, Massachusetts, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Mexico, New York, North Carolina, North Dakota, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Washington, Wisconsin, Wyoming and in Baltimore Maryland.

EPT is potentially allowable in Alabama, Delaware, Georgia, Kansas, Maryland, Montana, New Jersey, South Dakota, Virginia, and District of Colombia and Puerto Rico.

Information by state can be found online at the CDC website.

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