ACOG Recommends Expedited Partner Therapy for STIs

To prevent gonorrhea and chlamydial reinfection when a patient's partners are unable or unwilling to seek medical care, the American College of Obstetricians and Gynecologists (ACOG) supports the use of expedited partner therapy, according to a committee opinion published in the June issue of Obstetrics & Gynecology.

"In the United States, adolescent girls and young women aged 15–24 years consistently have the highest number of cases of gonorrhea and chlamydial infection," the opinion states. "One factor that contributes to young women's high rates of STIs is reinfection from an untreated sexual partner.... Expedited partner therapy enables the obstetrician–gynecologist or other provider to give prescriptions or medications to patients to take to their partners without first examining these partners."

ACOG also recommends patient counseling and written treatment instructions for the patient's partner or partners as part of this practice, including encouragement to undergo additional medical evaluation as soon as possible to discuss screening for HIV infection and other sexually transmitted infections (STIs).

The opinion notes that more women than men are affected by STIs and that prevention of reinfection can help protect their fertility. However, many legal, medical, practical, and administrative barriers to expedited partner therapy keep obstetrician-gynecologists from using it routinely.

Specific conclusions and recommendations are as follows:

ACOG supports the use of expedited partner therapy as a strategy to prevent gonorrhea and chlamydial reinfection when the patient's partners are unable or unwilling to seek medical care.
ACOG members should advocate to legalize expedited partner therapy and to collaborate with health departments to design protocols to implement it.
Obstetrician-gynecologists should counsel partners undergoing expedited partner therapy to have additional workup as soon as possible to discuss screening for HIV infection and other STIs.
Before offering expedited partner therapy, obstetrician-gynecologists or other providers should evaluate the risk for intimate partner violence associated with partner notification. Expedited partner therapy is contraindicated in cases of suspected child abuse, sexual assault, or any other conditions potentially compromising the patient's safety from her abuser.
Clinicians should refer to CDC or state and local guidelines for the most up-to-date recommendations on providing expedited partner therapy, including permissible medications.
Patients should refrain from sexual intercourse for 7 days after they and their partners have completed treatment.
A mechanism should be available for patients and partners to report adverse events.
Providers should determine allowable reimbursement options and requirements for expedited partner therapy based on the regulations and policies for their jurisdiction.

The opinion authors have disclosed no relevant financial relationships.

Obstet Gynecol. 2015;125:1526-1528. Full text

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