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Expedited partner therapy for treatable STIs

Health Factors: Sexual Activity
Decision Makers: State Government Healthcare Professionals & Advocates Public Health Professionals & Advocates
Evidence Rating: Scientifically Supported
Population Reach: 1-9% of WI's population
Impact on Disparities: No impact on disparities likely

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Description

In expedited partner therapy (EPT), health care providers give medications or prescriptions to patients diagnosed with a treatable STI, such as chlamydia or gonorrhea, to give to their sex partner(s) without the provider first examining the partner(s). Medications or prescriptions are generally provided for partners from the prior 60 days, or to the most recent partner if the patient has not had sex in the 60 days prior to diagnosis. The Centers for Disease Control and Prevention (CDC) recommends that medications or prescriptions be accompanied by treatment instructions, applicable warnings about taking medication (e.g., pregnancy or allergy), general health counseling, and a statement advising partners to seek medical evaluation for any symptom of an STI (CDC-STD 2015). EPT is one option in a comprehensive strategy for partner management, and does not replace other strategies such as provider-assisted referral (CDC-EPT).

Expected Beneficial Outcomes

Reduced incidence of STIs
Increased STI treatment

Evidence of Effectiveness

There is strong evidence that expedited partner therapy (EPT) increases the number of partners treated for sexually transmitted infections (STIs) such as chlamydia and gonorrhea in heterosexual populations (CDC-STD 2015, Cochrane-Ferreira 2013, Gift 2011, Hogben 2016), and prevents reinfection of the index patient (Cochrane-Ferreira 2013). EPT appears to be more effective for gonorrhea than for chlamydia (CDC-STD 2015, Cochrane-Ferreira 2013). Additional evidence is needed to determine EPT’s effects for other diseases and populations (CDC-EPT).

Use of EPT is highest in states with laws authorizing EPT, and where professional boards (e.g., state medical boards and pharmacy boards) have policy statements supporting its use (Cramer 2013). Receiving information on EPT (Taylor 2011) and having clear legal guidelines appear to increase the likelihood of provider use of EPT (Rosenfeld 2016a). Providing EPT to clinicians may increase its use (Golden 2015).

The Centers for Disease Control and Prevention (CDC) recommends providing medication for partners, rather than prescriptions, as partners often do not fill the prescriptions they receive (CDC-STD 2015), though a small New York City-based study suggests that prescription EPT and medication EPT may lead to comparable rates of partner treatment (Oliver 2016).

When used for chlamydia and gonorrhea, EPT appears to be more cost effective for health care systems and society as a whole than other forms of partner referral. EPT for chlamydia and gonorrhea can also be cost effective for individual payers when approximately one-third of treated partners receive care from the same payer (Gift 2011).

EPT may create missed opportunities to test for HIV and other STIs if partners do not follow-up with their own health care providers (Kerani 2013). The CDC recommends that anyone receiving a bacterial STI diagnosis and their sex partners be tested for HIV (CDC-STD 2015).

Implementation

United States

Expedited partner therapy (EPT) is legally permissible in 38 states, potentially allowable in 8 states, and prohibited in 4 states as of December 2016 (CDC-Legal status EPT).

Wisconsin

Wisconsin physicians, physician assistants, or certified nurse prescribers may provide expedited partner therapy (EPT) if patients are diagnosed with chlamydia, gonorrhea, or trichomaniasis as of 2010 (CDC-Legal status EPT).

Implementation Resources

CDC-EPT - Centers for Disease Control and Prevention (CDC). Expedited Partner Therapy (EPT). Accessed on January 31, 2017
CDC-STD 2015 - Workowski KA, Bolan GA. Sexually transmitted diseases treatment guidelines, 2015. Morbidity and Mortality Weekly Report (MMWR). 2015;64(RR-3):1-137. Accessed on January 30, 2017

Citations - Description

CDC-EPT - Centers for Disease Control and Prevention (CDC). Expedited Partner Therapy (EPT). Accessed on January 31, 2017
CDC-STD 2015 - Workowski KA, Bolan GA. Sexually transmitted diseases treatment guidelines, 2015. Morbidity and Mortality Weekly Report (MMWR). 2015;64(RR-3):1-137. Accessed on January 30, 2017

Citations - Evidence

CDC-EPT - Centers for Disease Control and Prevention (CDC). Expedited Partner Therapy (EPT). Accessed on January 31, 2017
CDC-STD 2015 - Workowski KA, Bolan GA. Sexually transmitted diseases treatment guidelines, 2015. Morbidity and Mortality Weekly Report (MMWR). 2015;64(RR-3):1-137. Accessed on January 30, 2017
Cochrane-Ferreira 2013* - Ferreira A, Young T, Mathews C, Zunza M, Low N. Strategies for partner notification for sexually transmitted infections, including HIV. Cochrane Database of Systematic Reviews. 2013;(10):CD002843. Accessed on January 30, 2017
Cramer 2013 - Cramer R, Leichliter JS, Stenger MR, Loosier PS, Slive L. The legal aspects of expedited partner therapy practice: Do state laws and policies really matter? Sexually Transmitted Diseases. 2013;40(8):657-662. Accessed on January 30, 2017
Gift 2011* - Gift TL, Kissinger P, Mohammed H, et al. The cost and cost-effectiveness of expedited partner therapy compared with standard partner referral for the treatment of chlamydia or gonorrhea. Sexually Transmitted Diseases. 2011;38(11):1067-1073. Accessed on January 30, 2017
Golden 2015 - Golden MR, Kerani RP, Stenger M, et al. Uptake and population-level impact of expedited partner therapy (EPT) on Chlamydia trachomatis and Neisseria gonorrhoeae: The Washington State community-level randomized trial of EPT. Low N, ed. PLOS Medicine. 2015;12(1):e1001777. Accessed on January 30, 2017
Hogben 2016 - Hogben M, Collins D, Hoots B, O?Connor K. Partner services in STD prevention programs: A review. Sexually Transmitted Diseases. 2016;43(Suppl 1):S53-S62. Accessed on January 30, 2017
Kerani 2013* - Kerani RP, Fleming M, Golden MR. Acceptability and intention to seek medical care after hypothetical receipt of patient-delivered partner therapy or electronic partner notification postcards among men who have sex with men: The partner’s perspective. Sexually Transmitted Diseases. 2013;40(2):179-185. Accessed on January 30, 2017
Oliver 2016* - Oliver A, Rogers M, Schillinger JA. The impact of prescriptions on sex partner treatment using expedited partner therapy for Chlamydia trachomatis infection, New York City, 2014–2015. Sexually Transmitted Diseases. 2016;43(11):673-678. Accessed on February 6, 2017
Rosenfeld 2016a* - Rosenfeld EA, Marx J, Terry MA, et al. Perspectives on expedited partner therapy for chlamydia: A survey of health care providers. International Journal of STD & AIDS. 2016;27(13):1180-1186. Accessed on January 30, 2017
Taylor 2011* - Taylor MM, Collier MG, Winscott MM, Mickey T, England B. Reticence to prescribe: Utilization of expedited partner therapy among obstetrics providers in Arizona. International Journal of STD & AIDS. 2011;22(8):449-452. Accessed on January 30, 2017

Citations - Implementation

CDC-Legal status EPT - Centers for Disease Control and Prevention (CDC). Legal Status of Expedited Partner Therapy (EPT). Accessed on January 30, 2017

Page Last Updated

February 3, 2017

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