Guidance on the Use of Expedited Partner Therapy in the Treatment of Gonorrhea
Expedited Partner Therapy (EPT) is a partner treatment approach where sex partners of patients who test positive for certain sexually transmitted diseases are provided treatment without previous medical evaluation. Because of EPT’s effectiveness in reducing gonorrhea reinfection rates1, CDC has recommended its use since 2006 for the heterosexual partners of patients diagnosed with gonorrhea if it was unlikely the partners would seek timely evaluation and treatment.2
At present, the only CDC-recommended treatment of uncomplicated urogenital, anorectal, and pharyngeal gonorrhea is monotherapy with a single intramuscular dose of ceftriaxone 500 mg. If EPT via injection is not possible, CDC recommends 800mg cefixime orally in a single dose.3 CDC continues to recommend EPT for heterosexual men and women with gonorrhea for whom health department partner-management strategies are impractical or unavailable and whose providers are concerned about partners’ access to prompt clinical evaluation and treatment. This document is intended to provide guidance to providers who choose to use EPT for gonorrhea, and to answer frequently asked questions.
1. In light of CDC’s recent changes to its gonorrhea treatment recommendations, can EPT be used for gonorrhea?
- Under current guidelines every effort should be made to ensure that a patient’s sex partners are evaluated and treated with the recommended regimen (a single dose of ceftriaxone 500 mg IM). However, because that is not always possible, providers should still consider EPT for partners of patients diagnosed with gonorrhea who are unlikely to access timely evaluation and treatment. MSM with gonorrhea have a high risk for coexisting infections (especially undiagnosed HIV) among their partners, and they might have partners without HIV who could benefit from PrEP. Data are also limited regarding the effectiveness of EPT in reducing persistent or recurrent gonorrhea among MSM 4,5; thus, shared clinical decision-making regarding EPT for MSM is recommended.
2. Since CDC no longer recommends exclusively oral treatment for gonorrhea, how does CDC recommend EPT be practiced for gonorrhea?
- In cases where gonorrhea expedited partner therapy (provision of prescriptions or medications for the patient to take to his or her sex partner without the health care provider first examining the partner) is permissible by state law and the partner is unable or unlikely to seek timely treatment, the partner may be treated with a single 800 mg dose of cefixime, if a chlamydia infection in the patient has been excluded. If a chlamydia test result has not been documented, the partner may be treated with a single dose of oral cefixime 800 mg plus oral doxycycline 100 mg 2 times/day for 7 days. If adherence with multiday dosing is a considerable concern, azithromycin 1 g can be considered but has lower treatment efficacy among persons with rectal chlamydia (see Chlamydial Infections). As has always been the case, medication or prescriptions provided as part of EPT should be accompanied by treatment instructions, appropriate warnings about taking medications (if the partner is pregnant or has an allergy to the medication), general gonorrhea health education and counseling, and a statement advising that partners seek personal medical evaluation, particularly women with symptoms of PID.6
- Golden MR, Whittington WL, Handsfield HH, Hughes JP, Stamm WE, Hogben M, Clark A, Malinski C, Helmers JR, Thomas KK, Holmes KK. Effect of expedited treatment of sex partners on recurrent or persistent gonorrhea or chlamydial infection. N Engl J Med. 2005 Feb 17;352(7):676-85.
- Centers for Disease Control & Prevention (CDC). 2015 Sexually Transmitted Diseases Treatment Guidelines. Atlanta: U.S. Department of Health and Human Services; 2015. Accessed Aug. 19, 2015.
- St. Cyr S, Barbee L, Workowski KA, et al. Update to CDC’s Treatment Guidelines for Gonococcal Infection, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1911–1916. DOI: http://dx.doi.org/10.15585/mmwr.mm6950a6external icon.
- 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. 2005;40:787–93.
- Schillinger J, Jamison K, Slutsker J, et al. STI and HIV infections among MSM reporting exposure to gonorrhea or chlamydia: implications for expedited partner therapy. Sex Transm Infect. 2019;95:A107.
- Expedited Partner Therapy. August 9, 2012. Available at: https://www.cdc.gov/std/ept/default.htm. Accessed Aug. 6, 2013