Expedited partner therapy for treatable STIs
In expedited partner therapy (EPT), also called patient-delivered partner therapy, health care providers give medications or prescriptions to patients diagnosed with a treatable sexually transmitted infection (STI), such as chlamydia or gonorrhea, to give to their sex partner(s) without the provider first examining the partner(s). Medications or prescriptions are generally provided for partners from the prior 60 days, or to the most recent partner if the patient has not had sex in the 60 days prior to diagnosis. The Centers for Disease Control and Prevention (CDC) recommends that medications or prescriptions be accompanied by treatment instructions, applicable warnings about taking medication (e.g., pregnancy or allergy), general health counseling, and a statement advising partners to seek medical evaluation for any symptom of an STI1. EPT is one option in a comprehensive strategy for partner management and does not replace other strategies such as provider-assisted referral2.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
Reduced incidence of STIs
Increased STI treatment
What does the research say about effectiveness?
There is strong evidence that expedited partner therapy (EPT) increases the number of partners treated for sexually transmitted infections (STIs) such as chlamydia and gonorrhea in heterosexual populations1, 3, 4, 5, 6, and prevents reinfection of the index patient3, 6. EPT appears to be more effective for gonorrhea than for chlamydia1, 3. Additional evidence is needed to determine EPT’s effects for other diseases and populations2, including adolescents7.
Use of EPT is highest in states with laws authorizing EPT, and where professional boards (e.g., state medical boards and pharmacy boards) have policy statements supporting its use8. States without such laws appear to have increased chlamydia rates9. Passage of laws authorizing EPT does not appear to reduce rates of gonorrhea infection; however, that may be due to a lack of provider awareness and patient acceptance10. Receiving information on EPT11 and having clear legal guidelines appear to increase the likelihood of provider use of EPT12. Providing free EPT to clinicians may increase its use13.
The Centers for Disease Control and Prevention (CDC) recommends providing medication for partners, rather than prescriptions, as partners often do not fill the prescriptions they receive1, though a small New York City-based study suggests that prescription EPT and medication EPT may lead to comparable rates of partner treatment14.
When used for chlamydia and gonorrhea, EPT appears to be more cost effective for health care systems and society as a whole than other forms of partner referral. EPT for chlamydia and gonorrhea can also be cost effective for individual payers when approximately one-third of treated partners receive care from the same payer4.
EPT may create missed opportunities to test for HIV and other STIs if partners do not follow-up with their own health care providers15. The CDC recommends that anyone receiving a bacterial STI diagnosis and their sex partners be tested for HIV1.
How could this strategy impact health disparities? This strategy is rated no impact on disparities likely.
Implementation Examples
Expedited partner therapy (EPT) is legally permissible in 44 states, potentially allowable in 5 states, and prohibited in 1 state as of June 201916.
Implementation Resources
CDC-EPT - Centers for Disease Control and Prevention (CDC). Expedited Partner Therapy (EPT).
CDC-STD 2015 - Workowski KA, Bolan GA. Sexually transmitted diseases treatment guidelines, 2015. Morbidity and Mortality Weekly Report (MMWR). 2015;64(RR-3):1-137.
Footnotes
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1 CDC-STD 2015 - Workowski KA, Bolan GA. Sexually transmitted diseases treatment guidelines, 2015. Morbidity and Mortality Weekly Report (MMWR). 2015;64(RR-3):1-137.
2 CDC-EPT - Centers for Disease Control and Prevention (CDC). Expedited Partner Therapy (EPT).
3 Cochrane-Ferreira 2013 - Ferreira A, Young T, Mathews C, Zunza M, Low N. Strategies for partner notification for sexually transmitted infections, including HIV. Cochrane Database of Systematic Reviews. 2013;(10):CD002843.
4 Gift 2011 - Gift TL, Kissinger P, Mohammed H, et al. The cost and cost-effectiveness of expedited partner therapy compared with standard partner referral for the treatment of chlamydia or gonorrhea. Sexually Transmitted Diseases. 2011;38(11):1067-1073.
5 Hogben 2016 - Hogben M, Collins D, Hoots B, O'Connor K. Partner services in STD prevention programs: A review. Sexually Transmitted Diseases. 2016;43(Suppl 1):S53-S62.
6 Trelle 2007 - Trelle S, Shang A, Nartey L, et al. Improved effectiveness of partner notification for patients with sexually transmitted infections: Systematic review. British Medical Journal. 2007;34(7589):354–357.
7 Gannon-Loew 2017 - Gannon-Loew KE, Holland-Hall C, Bonny AE. A review of expedited partner therapy for the management of sexually transmitted infections in adolescents. Journal of Pediatric and Adolescent Gynecology. 2017;30(3):341–348.
8 Cramer 2013 - Cramer R, Leichliter JS, Stenger MR, Loosier PS, Slive L. The legal aspects of expedited partner therapy practice: Do state laws and policies really matter? Sexually Transmitted Diseases. 2013;40(8):657-662.
9 Mmeje 2018 - Mmeje O, Wallett S, Kolenic G, et al. Impact of expedited partner therapy (EPT) implementation on chlamydia incidence in the USA. Sexually Transmitted Infections. 2018;94(7):545–547.
10 Owusu-Edusei 2017 - Owusu-Edusei K, Cramer R, Chesson HW, et al. State-level gonorrhea rates and expedited partner therapy laws: Insights from time series analyses. Public Health. 2017;147:101–108.
11 Taylor 2011 - Taylor MM, Collier MG, Winscott MM, Mickey T, England B. Reticence to prescribe: Utilization of expedited partner therapy among obstetrics providers in Arizona. International Journal of STD & AIDS. 2011;22(8):449-452.
12 Rosenfeld 2016a - Rosenfeld EA, Marx J, Terry MA, et al. Perspectives on expedited partner therapy for chlamydia: A survey of health care providers. International Journal of STD & AIDS. 2016;27(13):1180-1186.
13 Golden 2015 - Golden MR, Kerani RP, Stenger M, et al. Uptake and population-level impact of expedited partner therapy (EPT) on Chlamydia trachomatis and Neisseria gonorrhoeae: The Washington State community-level randomized trial of EPT. Low N, ed. PLOS Medicine. 2015;12(1):e1001777.
14 Oliver 2016 - Oliver A, Rogers M, Schillinger JA. The impact of prescriptions on sex partner treatment using expedited partner therapy for Chlamydia trachomatis infection, New York City, 2014–2015. Sexually Transmitted Diseases. 2016;43(11):673-678.
15 Kerani 2013 - Kerani RP, Fleming M, Golden MR. Acceptability and intention to seek medical care after hypothetical receipt of patient-delivered partner therapy or electronic partner notification postcards among men who have sex with men: The partner’s perspective. Sexually Transmitted Diseases. 2013;40(2):179-185.
16 CDC-Legal status EPT - Centers for Disease Control and Prevention (CDC). Legal status of Expedited Partner Therapy (EPT).
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