Expedited Partner Therapy | Questions & Answers | 2010 Treatment Guidelines
Question 1: EPT is discussed at length. Is it legal in Florida? How do I find out if it is?
Answer: The legal status of Expedited Partner Therapy (EPT) is evolving and varies from state to state. Visit http://www.cdc.gov/std/ept/legal/default.htm to find an analysis of legal provisions that could implicate the legality of EPT in your state. Official state and local legal counsel should be consulted for specific legal guidance. Additional information about EPT, including a legal/policy toolkit for adoption and implementation of EPT, can be found at http://www.cdc.gov/std/ept/legal/LegalToolkit.htm.
Question 2: Please provide EPT guidelines for chlamydia and gonorrhea with explicit information about preferred option first, and then alternate options.
Patients diagnosed with chlamydia should be instructed to refer their sex partners for evaluation, testing, and treatment if they had sexual contact with the patient during the 60 days preceding onset of the patient’s symptoms or diagnosis (the most recent sex partner should be evaluated and treated, even if the time of the last sexual contact was >60 days before symptom onset or diagnosis). Some partners may not seek evaluation and treatment. In such cases, for heterosexual partners of patients diagnosed with chlamydia, CDC recommends azithromycin 1.0 g orally in a single dose, or doxycycline 100 mg orally twice a day for 7 days. Alternative EPT regimens for chlamydia include erythromycin base 500 mg orally four times a day for 7 days, or erythromycin ethylsuccinate 800 mg orally four times a day for 7 days, or levofloxacin 500 mg orally once daily for 7 days, or ofloxacin 300 mg orally twice a day for 7 days. When providing EPT for chlamydia, consider concurrent treatment for gonococcal infection if the prevalence of gonorrhea is high in the patient population.
For all patients with gonorrhea, every effort should be made to ensure that the patients' sex partners from the preceding 60 days are evaluated and treated for N. gonorrhoeae with a recommended regimen. If a heterosexual partner of a patient cannot be linked to evaluation and treatment in a timely fashion, then expedited partner therapy should be considered, using oral combination antimicrobial therapy for gonorrhea (cefixime 400 mg and azithromycin 1 g) delivered to the partner by the patient, a disease investigation specialist, or through a collaborating pharmacy. The patient should return 1 week after treatment for a test-of-cure at the infected anatomic site. The test-of-cure ideally should be performed with culture or with a NAAT for N. gonorrhoeae if culture is not readily available. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6131a3.htm?s_cid=mm6131a3_w
Question 3: What is the clinician's liability for treatment of a partner who may have drug allergies unknown to the provider?
Answer: CDC cannot provide legal guidance or advice on liability for clinicians’ practicing EPT. This issue should be discussed with official state and local legal counsel. Claims of medical malpractice against physicians using EPT to treat chlamydia and gonorrhea are theoretically possible. However, since the risk of adverse reactions to the antibiotics used in EPT to treat these infections is minimal and can be managed with reasonable care and precautions, the threat of medical malpractice claims is comparably low. CDC is not aware of reported cases in which courts have specifically addressed the liability of healthcare practitioners or entities for partner injuries through the practice of EPT. A lack of reported judicial decisions, however, does not mean that liability claims have not arisen or that they have not been settled out of court. Addressing potential liability claims underlying EPT requires jurisdiction-specific analyses due to variations in state and local laws. Several states have included specific language on liability in legislation that authorizes EPT to address this concern. A legal/policy toolkit for adoption and implementation of EPT is available at http://www.cdc.gov/std/ept/legal/LegalToolkit.htm, which includes sample legislative language on liability issues and a discussion of issues related to liability.