EPT gets support from ACOG

If you haven't included expedited partner therapy (EPT) in your practice of treating patients with gonorrhea and chlamydia, more support for the measure has arrived in the form of a new committee opinion from the American College of Obstetricians and Gynecologists.1 The national organization is calling for providers to prescribe antibiotics for the male partners of their female patients diagnosed with chlamydia or gonorrhea to reduce high reinfection rate, as well as to push for legalization of expedited partner therapy in those states and jurisdictions where it is illegal or where the legal status of EPT is unclear or ambiguous.1

Chlamydia and gonorrhea are the top two most commonly reported sexually transmitted infections (STIs) in the United States. Girls ages 15-19 and young women ages 20-24 are especially impacted: The largest number of reported cases in 2009 of both STIs was among females in these two age groups.2

Evidence indicates that EPT can decrease reinfection rates compared to standard partner referrals for examination and treatment, said Diane Merritt, MD, chair of ACOG's Committee on Adolescent Health Care in a press release accompanying the publication. "Of course, it's preferable that a physician examine a patient in-person before prescribing medication, but the benefits of EPT among individuals whose partners are otherwise unlikely to seek care in preventing chlamydia and gonorrhea reinfections outweigh the risks to the partners," noted Merritt.

Available evidence indicates that EPT is at least equally effective to standard partner management for gonorrhea and chlamydia, notes Gail Bolan, MD, director of the Division of Sexually Transmitted Disease Prevention at the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention in the Centers for Disease Control and Prevention (CDC). Evidence also indicates that traditional partner management by public health agencies and healthcare providers for these sexually transmitted infections (STIs) often is not feasible and that the benefits of EPT outweigh the risks, states Bolan. "We are pleased to hear that ACOG joins the list of professional organizations that now endorse EPT," Bolan comments. "These endorsements are important elements in establishing a standard of care for EPT."

Get on board

According to the CDC's most recent analysis, EPT might be legally permissible in 30 states, states Bolan. However, it is not widely practiced among many practitioners due to numerous barriers, including policies that don't allow for reimbursement for the cost of partner treatment, she notes.

"We hope that the ACOG opinion will encourage more practitioners to practice EPT to prevent reinfection of STIs and work with stakeholders to remove barriers to its implementation," says Bolan. 

The CDC has developed a toolkit to help policymakers and practitioners address barriers related to EPT implementation, notes Bolan. The information can be found at www.cdc.gov/std/ept.

Chlamydia and gonorrhea are infections that might not cause symptoms, or if they do, their presentation — vaginal or penile discharge, abnormal vaginal bleeding, cramping — might not set off warning bells in those who are infected. "Many people who have an STI are not aware of it and pass it to their partners," said Merritt. "Undiagnosed and untreated STIs can cause scarring and damage a woman's ability to become pregnant when she's ready to have a baby.

Chlamydia and gonorrhea can be quickly diagnosed with a simple urine test and treated with a short course of antibiotics, notes ACOG.

More data coming

Researchers in Washington state are doing a final analysis of data in a community-level trial of EPT. The goal of the study is to determine if an EPT program can decrease the prevalence of chlamydia and/or the incidence of gonorrhea in the state's women.

Case report-based triage appears to be working, which confirms earlier experience in King County3, reported Matthew Golden, MD, MPH, professor in the Department of Medicine and adjunct professor of epidemiology at the University of Washington, at the 2011 International Society for Sexually Transmitted Diseases Research in Quebec City, Canada.4 The program appears to have increased patient-delivered partner therapy use by providers and partner treatment, though not in all areas. Effect on prevalence of infection are yet to be defined, he stated.4

References

  1. Committee opinion no. 506: expedited partner therapy in the management of gonorrhea and chlamydia by obstetrician-gynecologists. Obstet Gynecol 2011; 118:761-766.
  2. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2009. Atlanta: Department of Health and Human Services; 2010.
  3. Golden MR, Hughes JP, Brewer DD, et al. Evaluation of a population-based program of expedited partner therapy for gonorrhea and chlamydial infection. Sex Transm Dis 2007; 34:598-603.
  4. Golden MR. Expedited partner therapy. Presented at the International Society for STD Research. Quebec City, Canada; 2011.