EXECUTIVE SUMMARY

States with the most permissible expedited partner therapy (EPT) laws may demonstrate the most success treating and preventing sexually transmitted infections (STIs), results of a new study suggest.

  • The CDC estimates that undiagnosed STIs cause infertility in more than 20,000 women each year. One factor that contributes to young women’s high rates of STIs is reinfection from an untreated sexual partner.
  • Even after EPT legislation is enacted, there may be concurrent issues that need to be addressed to gain its full benefits. Many insurers may not cover medication costs for partners, and some clinicians may be hesitant to treat patients without an exam, citing liability concerns.

States with the most permissible expedited partner therapy (EPT) laws may demonstrate the most success treating and preventing sexually transmitted infections (STIs), according to a new study.1

Although both young men and women are affected heavily by STIs, young women face the most serious long-term health consequences. The CDC estimates that undiagnosed STIs cause infertility in more than 20,000 women each year.2 One factor that contributes to young women’s high rates of STIs is reinfection from an untreated sexual partner.3 These and other findings led the American College of Obstetricians and Gynecologists to issue a Committee Opinion in 2015 that called 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 EPT in those states and jurisdictions where it is illegal or where the legal status of EPT is unclear or ambiguous.4

According to lead author Okeoma Mmeje, MD, assistant professor of obstetrics and gynecology at Michigan Medicine and a member of the University of Michigan Institute for Healthcare Policy and Innovation, the research began as an offshoot of another project examining legislation and its interaction with patients.

“We saw expedited partner therapy as one of these types of legislation that may influence the patient and provider interaction,” Mmeje says.

To perform the analysis of the effect of EPT legal status (permissible, potentially allowable, or prohibited) on C. trachomatis infection rates for each state, researchers analyzed reported chlamydia cases from 2000-2013. Their analysis indicated that on average, disease incidence in states with prohibitive EPT legislation grew significantly faster than in states where EPT was allowed.1

In states that prohibit EPT, the analysis indicated that the average increase in the incidence of chlamydia infection is 17.5 cases per 100,000 per year, compared with 14.1 cases in states where EPT is legal.1

“There are many barriers preventing people from making an office visit, from transportation and inconvenience to access to a free clinic,” Mmeje said a statement accompanying the report. “Allowing doctors to treat both patients and their partners in this way has proven to be effective at preventing reinfection and the spread of infections such as chlamydia and gonorrhea. Long term, there are many societal benefits both in health and cost.”

Do you know the status of EPT legislation in your state? Stephanie Arnold Pang, director of policy and communications for the National Coalition of STD Directors, says clinicians can find out by checking out the EPT map, maintained by the CDC, at: http://bit.ly/2sofAfl. As of July 1, Georgia became the latest state to allow EPT. (To read more about the state’s enabling legislation, please visit: http://bit.ly/2rmUFcF.)

Providers, public health officials, and legislators who wish to see pro-EPT legislation passed in their states can get information from the CDC’s dedicated web page on the subject. (http://bit.ly/2sxdbP9)

The National Coalition of STD Directors also has been a part of the policy process in many states by helping facilitate coalitions, creating materials, and providing organizational support.

Even after lawmakers enact EPT legislation, there may be concurrent issues legislatures need to address to unlock EPT’s full benefits.

Many insurers may not cover medication costs for partners, and some clinicians may be hesitant to treat patients without an exam, citing liability concerns. The University of Michigan research team continues to examine barriers to practicing EPT in Michigan, where legislation became effective in 2015.

“EPT helps circumvent some of the most common barriers to patients receiving the care they need,” Mmeje said in the statement released with her team’s report. “Our findings provide strong reasons to re-examine policies that make it difficult to access a public health measure that we know can help treat and prevent sexually transmitted diseases.”

REFERENCES

  1. Mmeje O, Wallett S, Kolenic G, et al. Impact of expedited partner therapy (EPT) implementation on chlamydia incidence in the USA. Sex Transm Infect 2017; doi: 10.1136/sextrans-2016-052887.
  2. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2014. Atlanta: U.S. Department of Health and Human Services; 2015.
  3. Batteiger BE, Tu W, Ofner S, et al. Repeated Chlamydia trachomatis genital infections in adolescent women. J Infect Dis 2010; 201:42-51.
  4. Committee opinion no 632: Expedited partner therapy in the management of gonorrhea and chlamydial infection. Obstet Gynecol 2015;125:1526-1528.