Expedited Partner Therapy Aids STD Treatment


NEW YORK — Asking patients to deliver therapy for sexually transmitted diseases to their sexual partners is paying off with increases in the proportion of partners who are being treated, according to data from researchers in Washington state.

The Centers for Disease Control and Prevention advises that expedited partner therapy (EPT), or treating sexual partners without requiring that they first seek a medical evaluation, is an option when other management strategies are impractical or unsuccessful.

In Washington state, public health officials advise that EPT should be given when treatment cannot otherwise be en-sured, according to Dr. Matthew Golden, director of the STD Control Program for Public Health in Seattle/King County.

But EPT isn't a cure-all, Dr. Golden said at a joint conference of the American Sexually Transmitted Diseases Association and the British Association for Sexual Health and HIV. There are also groups of people who will not get their partners treated. Risk factors include having more than one partner and/or having a partner one is unlikely to have sex with again. “They are a definable group of people who really need our assistance,” he said.

As a result, health officials in King County have developed a case report form to try to triage the more intensive partner notification services, such as the use of disease intervention specialists.

The case report form, which is completed by the diagnosing physician, allows physicians to check a box stating that the health department should assume responsibility for partner notification.

Health officials recommend this option when the patient has more than one sex partner or a partner he or she is unlikely to have sex with again, the patient is a man who has sex with men, or the patient says that he or she is not going to notify their partners.

As part of the initiative, patients and their partners have free access to medications through large clinics and commercial pharmacies.

Use of the case report form has yielded encouraging results. A random sample of individuals diagnosed with gonorrhea or chlamydia showed that about 39% were classified as having all partners treated before the intervention, compared with 65% in the postintervention period (Sex. Transm. Dis. 2007;34:598-603).

And the initiative also seems to have an impact on morbidity, based on preliminary data from a simulation model, said Dr. Golden.

He and his colleagues used the model and estimated that if the trends continue, there would be about a 25% reduction in chlamydial prevalence in about 2 years' time and a 50% reduction in chlamydial prevalence in 4 years' time.

On the basis of the King County data, Dr. Golden and his colleagues are now conducting a community-level, randomized controlled trial throughout the state of Washington. They hope that this larger study will establish whether EPT reduces the prevalence of chlamydial infection and the incidence of gonorrhea at a population level, Dr. Golden said.

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