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Expedited Partner Treatment for Sexually Transmitted Infections: An Update

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Abstract

To date, seven randomized trials have evaluated the efficacy of expedited partner treatment (EPT). These trials have included heterosexual men and women and examine EPT for Chlamydia trachomatis, Neisseria gonorrhoea, and Trichomonas vaginalis. These studies demonstrated either superiority for percentage of partners being treated, for a reduction in repeat infections, or cost benefit for EPT compared to the standard partner referral method and reported no adverse events. In the United States, although the number of states where EPT is legal continues to grow, adoption of EPT remains low. Provider concerns about liability and payment issues continue to be a barrier to implementation of EPT. More translational research is needed to improve adoption by the players involved: index patients, partners, providers, and payers.

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  1. CDC: Program operations guidance: Partner Services. Atlanta, GA 2000.

  2. McCree D, Liddon N, Hogben M, St Lawrence J: National survey of doctors’ actions following the diagnosis of bacterial STD. Sex Trans Dis. 2003;79(3):254–256.

    CAS  Google Scholar 

  3. Oh M, Boker J, Genuardi F, et al.: Sexual contact tracing outcome in adolescent chlamydial and gonococcal cervicitis cases. J Adolesc Health. 1996;18(1):4–9.

    Article  PubMed  CAS  Google Scholar 

  4. CDC: Expedited partner therapy in the management of sexually transmitted diseases. Atlanta, GA: U.S. Department of Health and Human Services; 2006.

    Google Scholar 

  5. Stekler J, Bachmann L, Brotman RM, et al.: Concurrent sexually transmitted infections (STIs) in sex partners of patients with selected STIs: implications for patient-delivered partner therapy. Clin Infect Dis. Mar 15 2005;40(6):787–793.

    Article  PubMed  Google Scholar 

  6. Schillinger JA, Kissinger P, Calvet H, et al.: Patient-delivered partner treatment with azithromycin to prevent repeated Chlamydia trachomatis infection among women: a randomized, controlled trial. Sex Transm Dis. Jan 2003;30(1):49–56.

    Article  PubMed  CAS  Google Scholar 

  7. Golden MR, Whittington WL, Handsfield HH, et al.: Effect of expedited treatment of sex partners on recurrent or persistent gonorrhea or chlamydial infection. N Engl J Med. Feb 17 2005;352(7):676–685.

    Article  PubMed  CAS  Google Scholar 

  8. Kissinger P, Mohammed H, Richardson-Alston G, et al.: Patient-delivered partner treatment for male urethritis: a randomized, controlled trial. Clin Infect Dis. Sep 1 2005;41(5):623–629.

    Article  PubMed  Google Scholar 

  9. Kissinger P, Schmidt N, Mohammed H, et al.: Patient-delivered partner treatment for Trichomonas vaginalis infection: a randomized controlled trial. Sex Transm Dis. Jul 2006;33(7):445–450.

    Article  PubMed  Google Scholar 

  10. • Cameron ST, Glasier A, Scott G, et al.: Novel interventions to reduce reinfection in women with chlamydia: a randomized controlled trial. Hum Reprod. Apr 2009;24(4):888–895. PDK and PDPT do not reduce reinfection rates in women with chlamydia compared with patient referral. However, PDPT may offer other advantages, such as simplicity and cost compared with patient referral.

    Article  PubMed  CAS  Google Scholar 

  11. • Schwebke JR, Desmond RA: A randomized controlled trial of partner notification methods for prevention of trichomoniasis in women. Sex Transm Dis. Jun 2010;37(6):392–396. Rates of repeat trichomoniasis infection in women in PDPT intervention were lower than those in the public health disease intervention (DIS) arm and DIS/PR arm combined, although when compared directly to PR, there was no significant difference.

    PubMed  Google Scholar 

  12. Nuwaha F, Kambugu F, Nsubuga PS, et al.: Efficacy of patient-delivered partner medication in the treatment of sexual partners in Uganda. Sex Transm Dis. Feb 2001;28(2):105–110.

    Article  PubMed  CAS  Google Scholar 

  13. • Gatski M, Mena L, Levison J, et al.: Patient-delivered partner treatment and Trichomonas vaginalis repeat infection among HIV-infected women. Sex Transm Dis. May 24 2010. HIV-infected women with TV reported high adherence to PDPT, and treatment failure was the most common probable cause of repeat infection.

  14. Kissinger P, Amedee A, Clark RA, et al.: Trichomonas vaginalis treatment reduces vaginal HIV-1 shedding. Sex Transm Dis. Jan 2009;36(1):11–16.

    Article  PubMed  Google Scholar 

  15. • Mohammed H, Leichliter JS, Schmidt N, et al.: Does patient-delivered partner treatment improve disclosure for treatable sexually transmitted diseases? AIDS Patient Care STDS. Mar 2010;24(3):183–188. The provision of PDPT was associated with increased STD disclosure among men but not among women. Women had high rates of disclosure irrespective of intervention arm.

    Article  PubMed  Google Scholar 

  16. Gift T, Farley T, Leichliter J, Kissinger P: The cost-effectiveness of patient delivered partner treatment (PDPT) for female partners of men with urethritis compared to two alternatives. Paper presented at: 16th ISSTDR, 2005; Amsterdam.

  17. Centers for Disease Control and P, Workowski KA, Berman SM: Sexually transmitted diseases treatment guidelines, 2006.[erratum appears in MMWR Recomm Rep. 2006 Sep 15;55(36):997.]. Morbidity & Mortality Weekly Report Recommendations & Reports. Aug 4 2006;55(RR-11):1–94.

  18. • Shiely F, Hayes K, Thomas KK, et al.: Expedited partner therapy: a robust intervention. Sex Transm Dis. Oct 2010;37(10):602–607. EPT is shown to be superior to PR across a wide spectrum of sociodemographic and behaviorally defined subgroups.

    PubMed  CAS  Google Scholar 

  19. •• Stephens SC, Bernstein KT, Katz MH, et al.: The effectiveness of patient-delivered partner therapy and chlamydial and gonococcal reinfection in San Francisco. Sex Transm Dis. Aug 2010;37(8):525–529. Continued evaluation of PDPT on reinfection rates in real-world settings as well as cost-effectiveness analyses of PDPT are needed to assess this alternative method of partner treatment.

    PubMed  Google Scholar 

  20. Khan A, Fortenberry JD, Juliar BE, et al.: The prevalence of chlamydia, gonorrhea, and trichomonas in sexual partnerships: implications for partner notification and treatment. Sex Transm Dis. Apr 2005;32(4):260–264.

    Article  PubMed  Google Scholar 

  21. • Hodge JG Jr, Pulver A, Hogben M, et al.: Expedited partner therapy for sexually transmitted diseases: assessing the legal environment. Am J Public Health. Feb 2008;98(2):238–243. We determined that three fourths of states or territories either expressly permit EPT or do not expressly prohibit the practice. We recommend 1) expressly endorsing EPT, 2) creating exceptions to existing prescription requirements, 3) increasing professional board or association support for EPT, and 4) supporting third-party payments for partners’ medications.

    Article  PubMed  Google Scholar 

  22. • Davis CF, Cummings M, Coles BF, McNutt LA: Alternative Approaches to Partner Notification, Diagnosis, and Treatment: Perspectives of New York County Health Departments, 2007. Sex Transm Dis. Feb 9 2009. Further research on alternative partner intervention strategies and discussion of PDPT is necessary to develop a forward-thinking strategic plan for STD control in the state.

  23. • McNutt LA, Davis CF, Bednarczyk RA, et al.: Alternative Approaches to Partner Notification, Diagnosis, and Treatment: Pharmacists’ Perspectives on Proposed Patient Delivered Partner Therapy in New York State, 2007. Sex Transm Dis. Feb 9 2009. Pharmacists are open to considering PDPT as part of their professional functions. Altough pharmacists need additional education in STIs in general, capacity for this training can be developed. Confidentiality issues remain a priority issue to address to protect individuals treated through PDPT.

  24. • Golden MR, Hughes JP, Brewer DD, et al.: Evaluation of a population-based program of expedited partner therapy for gonorrhea and chlamydial infection. Sexually Transmitted Diseases. Aug 2007;34(8):598–603. A substantial minority of private-sector patients have untreated partners more than 7 days after their own treatment; some need help with PN, but most will agree to deliver medications themselves.

    PubMed  Google Scholar 

  25. • Young T, de Kock A, Jones H, et al.: A comparison of two methods of partner notification for sexually transmitted infections in South Africa: patient-delivered partner medication and patient-based partner referral. Int J STD AIDS. May 2007;18(5):338–340. Good communication emerged as the key to successful partner notification. PDPT could also be used as a strategy to improve STI treatment coverage.

    Article  PubMed  CAS  Google Scholar 

  26. • McBride KR, Goldsworthy RC, Fortenberry JD: Patient and partner perspectives on patient-delivered partner screening: acceptability, benefits, and barriers. AIDS Patient Care STDS. Oct 2010;24(10):631–637. When provided a choice of expedited partner services, users of clinical services selected both PDPT and patient-delived partner screening (PDPS) together, whether selecting as a deliverer (the index patient) or a receiver (the partner).

    Article  PubMed  Google Scholar 

  27. • McBride K, Goldsworthy RC, Fortenberry JD: Formative design and evaluation of patient-delivered partner therapy informational materials and packaging. Sex Transm Infect. Apr 2009;85(2):150–155. PDPT informational materials differentially affected participant willingness to receive (positively) and deliver (negatively) PDPT, positively influenced self-efficacy and understanding, and were perceived as easy to use.

    Article  PubMed  CAS  Google Scholar 

  28. Packel LJ, Guerry S, Bauer HM, et al.: Patient-delivered partner therapy for chlamydial infections: attitudes and practices of California physicians and nurse practitioners. Sexually Transmitted Diseases. Jul 2006;33(7):458–463.

    Article  PubMed  Google Scholar 

  29. Baltimore City Health D: Expedited partner therapry for partners of patients with gonorrhea or chlamydia: Report for pilot program activities 2008.

  30. Aral SO, Lipshutz J, Douglas JM, eds.: Behavioral Interventions for prevention and control of sexually transmitted diseases: Introduction. New York: Springer; 2007.

    Google Scholar 

  31. Yu Y, Frasure J, Bolan Gea: Evaluation of partner services for treatment of Chlamydia trachomatis in California family planning clinics. National STD Prevention Conference. Chicago, Il; 2008.

    Google Scholar 

  32. • McNulty A, Teh MF, Freedman E: Patient delivered partner therapy for chlamydial infection—what would be missed? Sexually Transmitted Diseases. Sep 2008;35(9):834–836. This study did not demonstrate that PDPT would be a worthwhile strategy to consider, particularly in heterosexual male partners in urban settings.

    Article  PubMed  Google Scholar 

  33. •• Kissinger PJ, Reilly K, Taylor SN, et al.: Early repeat Chlamydia trachomatis and Neisseria gonorrhoeae infections among heterosexual men. Sex Transm Dis. Aug 2009;36(8):498–500. CT and GC rescreening among heterosexual men yield high infection rates. Although much of the rescreen positive rate was driven by reinfection, treatment failure and new infections were also contributors. These data suggest rescreening among men, in addition to the provision of EPT, could be a useful public health strategy.

    Article  PubMed  Google Scholar 

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The findings and conclusions in this paper are those of the author(s) and do not necessarily represent the views of the Centers for Disease Control and Prevention.

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Conflicts of interest: P. Kissinger—none; M. Hogben—none.

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Correspondence to Patricia Kissinger.

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Kissinger, P., Hogben, M. Expedited Partner Treatment for Sexually Transmitted Infections: An Update. Curr Infect Dis Rep 13, 188–195 (2011). https://doi.org/10.1007/s11908-010-0159-3

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