By Rebecca Bowers

EXECUTIVE SUMMARY

Since 2006, the Centers of Disease Control and Prevention has recommended the use of expedited partner therapy (EPT) for treatment of sexually transmitted infections such as gonorrhea and chlamydia, but the infection rate continues to climb.

  • Although several major medical societies, such as the American Academy of Family Physicians, American Academy of Pediatrics, Society for Adolescent Health and Medicine, and American Congress of Obstetricians and Gynecologists, have endorsed the practice, EPT still is under-used across the country.
  • The transmission of undiagnosed sexually transmitted infections can cause serious health complications. If the infections are left untreated, women are at increased risk for pelvic inflammatory disease, chronic pelvic pain, and infertility. Untreated infections also raise the risk of HIV acquisition, research indicates.

The rate of sexually transmitted infections (STIs) such as gonorrhea and chlamydia continues to climb, despite the Centers for Disease Control and Prevention’s (CDC) recommendation of expedited partner therapy (EPT) since 2006. What are the barriers to providing more people with EPT?

Several major medical societies, including the American Academy of Family Physicians, American Academy of Pediatrics, Society for Adolescent Health and Medicine, and American Congress of Obstetricians and Gynecologists, have endorsed the practice, but EPT still is under-used across the country, noted a recent commentary in the American Journal of Public Health.1

“We need to make sure everyone in the medical and public health community has a basic understanding of what expedited partner therapy is, how it can work, and what it will take for it to reach widespread use,” says Cornelius Jamison, MD, MSPH, MSc, a family physician and member of the University of Michigan Department of Family Medicine and Institute for Healthcare Policy and Innovation. Jamison served as lead author for the paper, which seeks to offer guidance to overcome barriers to EPT by providing a conceptual framework about the potential barriers that exist.

Take a Closer Look

The transmission of undiagnosed STIs can cause serious health complications. If infections are left untreated, women are at increased risk for pelvic inflammatory disease, chronic pelvic pain, and infertility. Untreated infections also raise the risk of HIV acquisition, research indicates.2

STIs are on the rise; in 2016, there were more than 1.59 million reported cases of chlamydia, the highest number of annual cases ever reported to the CDC.3 Young women ages 15-24 accounted for 46% of reported chlamydia cases that year.3

Annual chlamydia and gonorrhea screenings are recommended for all sexually active women younger than 25 years of age, according to CDC guidance.4 Similar screening should be considered for men who report high-risk behaviors and in communities with a high burden of infection.4

EPT allows providers to give a prescription or medications to the heterosexual partners of patients diagnosed with chlamydia or gonorrhea without testing or examining the partner. The use of EPT is not recommended for the management of STIs in men who have sex with men because data demonstrating its effectiveness are lacking and there is a concern about missing STI and HIV coinfections among men in this population.5

The current CDC-recommended treatment for uncomplicated uro-genital, anorectal, and pharyngeal gonorrhea is combination therapy using one intramuscular dose of ceftriaxone 250 mg plus one 1-g oral dose of azithromycin.6 However, providers still should consider EPT for heterosexual partners of patients diagnosed with gonorrhea who are unlikely to access timely evaluation and treatment, the CDC advises.

What Is Your State’s Stance?

Forty-two states and the District of Columbia currently permit EPT use. (Check the map maintained by the CDC at http://bit.ly/2sofAfl to see the status of EPT laws in your state.) In 2017, Georgia became the most recent state to approve EPT use. EPT is “potentially allowable” in six states and Puerto Rico. However, EPT currently is prohibited in South Carolina and Kentucky.1

States such as Oklahoma are moving to advance the use of EPT. At the 2018 National STD Prevention Conference, members of the Oklahoma State Department of Health presented results showing that EPT is effective in preventing re-infection.6

Oklahoma implemented the EPT program in 78 of the county health department clinics as well as eight clinic sites at the Oklahoma City-County Health Department and the Tulsa Health Department. Researchers found that among 99% of patients who received EPT treatment, there were no reported reinfections within within 30-90 days of that first treatment.7

Such results are needed to stem the rising rates of STIs. In 2017, 31,779 cases of chlamydia, gonorrhea, and syphilis were diagnosed in Oklahoma, an increase from the 29,716 cases reported in 2016. Gonorrhea cases increased by nearly 20%, with a total of 21,752 cases of chlamydia reported.7

“Implementing EPT in Oklahoma is a huge victory and we are excited about improving treatment outcomes to help reduce rates of re-infection and adverse outcomes,” said Ivonna Mims, RN, BSN, an STD nurse consultant for HIV and STD Services at Oklahoma City-County Health Department, in a press release. “This scientifically proven method can ensure more Oklahomans have the availability of appropriate treatment for their partners.”

REFERENCES

  1. Jamison CD, Chang T, Mmeje O. Expedited partner therapy: Combating record high sexually transmitted infection rates. Am J Public Health 2018;108:1325-1327.
  2. Hayes R, Watson-Jones D, Celum C, et al. Treatment of sexually transmitted infections for HIV prevention: End of the road or new beginning? AIDS 2010;24(suppl 4):S15-S26.
  3. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2016. Atlanta, GA: US Department of Health and Human Services; 2017.
  4. Centers for Disease Control and Prevention. STD & HIV screening recommendations. Available at: https://bit.ly/2k53BhJ. Accessed Oct. 18, 2018.
  5. Centers for Disease Control and Prevention. Expedited Partner Therapy in the Management of Sexually Transmitted Diseases. Atlanta, GA: US Department of Health and Human Services; 2006.
  6. Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2015. Atlanta, GA: Centers for Disease Control and Prevention; 2015.
  7. Oklahoma State Department of Health. State cases of STDs follow national trend of steep increase. Press release. Aug. 29, 2018. Available at: https://bit.ly/2PwEOQW. Accessed Oct. 18, 2018.