Expedited Partner Therapy for STIs Reduces Reinfection Rate

Emma Hitt, PhD

March 15, 2010

March 15, 2010 (Atlanta) — Expedited partner therapy (EPT) for gonorrhea and chlamydia decreases visits for reinfection among sexually transmitted infection (STI) clinic patients in a real-world setting, according to new research findings.

Alisa K. Ames, MHS, from the Office of Epidemiology and Planning, Baltimore City Health Department, in Maryland, and colleagues presented the findings here at the 2010 National STD Prevention Conference.

"Clinical trials have shown that EPT is effective at reducing gonorrhea and chlamydia reinfection, compared with the partner management standard of patient referral," Ms. Ames told Medscape Infectious Diseases, "but we wanted to study whether this would be true in our setting of [STI] clinic patients in Baltimore. It was not obvious that we would see a benefit in our setting."

Heterosexual patients diagnosed with gonorrhea or chlamydia were routinely offered EPT for at least 1 partner from October 2007 until March 2009. Data were collected from 1085 patients, approximately half of them male. These findings were compared with data from a historic cohort of 2111 patients treated from January 2006 to June 2007 who were not offered EPT.

Significantly fewer reinfection events were noted in the EPT group than in the group not receiving EPT (2.1% vs 3.4%, respectively, P = .05).

The study's principle investigator, Emily Erbelding, MD, MPH, also from the BCHD, notes that legal barriers to EPT still exist in many states. "In Maryland, the law permits EPT only in BCHD clinics, not in the rest of Maryland and not in the private sector," she told Medscape Infectious Diseases.

Dr. Erbelding added that there are "other barriers too, such as who pays for the medication, particularly if the original patient is insured but partners are on another plan or not insured at all," she said. "Different public health jurisdictions have resolved those issues differently."

"The findings are consistent with 3 randomized controlled trials of EPT performed in the United States, so I think the results mostly confirm previous observations," said Matthew Golden MD, MPH, associate professor of medicine at the University of Washington Center for AIDS and STD, in Seattle.

"However, what's nice about this study is that it provides new real-world data supporting the findings from these trials," he told Medscape Infectious Diseases. "Also, it is encouraging to see that the intervention appears to have worked in the Baltimore [STI] clinics, which serve a very low-income urban population with extremely high rates of [STIs]," he said.

According to Dr. Golden, existing evidence supporting the routine use of EPT among heterosexuals is strong. "In states in which EPT is legal, clinicians should offer most heterosexual patients medications to give to their partners; these medications need to be dispensed with written information that includes an allergy warning."

According to the US Centers for Disease Control and Prevention (CDC), only about half of American clinicians who treat STI cases use EPT selectively, and only about 5% to 10% do so frequently or as their standard approach to partner management.

Providers can find additional information on EPT on the CDC Web site.

The evaluation was supported by the Baltimore City Health Department with no outside sponsorship. Ms. Ames and Dr. Erbelding have disclosed no relevant financial relationships. Dr. Golden reports that he has received free medication for research studies from Pfizer and Lupin Pharmaceuticals.

2010 National STD Prevention Conference (NSTDP): Abstract P86. Presented March 10, 2010.

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