Expedited Partner Therapy
Expedited partner therapy (EPT) is a harm-reduction strategy and the clinical practice of treating the sex partners of persons with diagnosed chlamydia or gonorrhea, who are unable or unlikely to seek timely treatment, by providing medications or prescriptions to the patient as allowable by law. Patients then provide partners with these therapies without the health care provider having examined the partner (https:// www.cdc.gov/std/ept). Unless prohibited by law or other regulations, medical providers should routinely offer EPT to patients with chlamydia when the provider cannot ensure that all of a patient’s sex partners from the previous 60 days will seek timely treatment. If the patient has not had sex during the 60 days before diagnosis, providers should offer EPT for the patient’s most recent sex partner. Because EPT must be an oral regimen and current gonorrhea treatment involves an injection, EPT for gonorrhea should be offered to partners unlikely to access timely evaluation after linkage is explored. EPT is legal in the majority of states but varies by chlamydial or gonococcal infection. Providers should visit https://www.cdc.gov/std/ept to obtain updated information for their state. Providing patients with packaged oral medication is the preferred approach because the efficacy of EPT using prescriptions has not been evaluated, obstacles to EPT can exist at the pharmacy level (121,122), and many persons (especially adolescents) do not fill the prescriptions provided to them by a sex partner (123,124). Medication or prescriptions provided for EPT should be accompanied by educational materials for the partner, including treatment instructions, warnings about taking medications (e.g., if the partner is pregnant or has an allergy to the medication), general health counseling, and a statement advising that partners seek medical evaluation as soon as possible for HIV infection and any symptoms of STIs, particularly PID.
Evidence supporting EPT is based on three U.S. clinical trials involving heterosexual men and women with chlamydia or gonorrhea (125–127). All three trials reported that more partners were treated when patients were offered EPT. Two reported statistically significant decreases in the rate of reinfection, and one observed a lower risk for persistent or recurrent infection that was statistically nonsignificant. A fourth trial in the United Kingdom did not demonstrate a difference in the risk for reinfection or in the numbers of partners treated between persons offered EPT and those advised to notify their sex partners (128). U.S. trials and a meta-analysis of EPT revealed that the magnitude of reduction in reinfection of index patients, compared with patient referral, differed according to the STI and the sex of the index patient (110,125–127). However, across trials, reductions in chlamydia prevalence at follow-up were approximately 20%, and reductions in gonorrhea were approximately 50% at follow-up.
Existing data indicate that EPT also might have a role in partner management for trichomoniasis; however, no partner management intervention has been reported to be more effective than any other in reducing trichomoniasis reinfection rates (129,130). No data support use of EPT in the routine management of patients with syphilis.
Data are limited regarding use of EPT for gonococcal or chlamydial infections among MSM, compared with heterosexuals (131,132). Published studies, including recent data regarding extragenital testing, indicated that male partners of MSM with diagnosed gonorrhea or chlamydia might have other bacterial STIs (gonorrhea or syphilis) or HIV (133–135). Studies have reported that 5% of MSM have a new diagnosis of HIV when evaluated as partners of men with gonococcal or chlamydial infections (133,134); however, more recent data indicate that, in certain settings, the frequency of HIV infection is much lower (135). Considering limited data and potential for other bacterial STIs among MSM partners, shared clinical decision-making regarding EPT is recommended. All persons who receive bacterial STI diagnoses and their sex partners, particularly MSM, should be tested for HIV, and those at risk for HIV infection should be offered HIV PrEP (https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2017.pdfpdf icon ).