What is Expedited Partner Therapy?

Young Couple at Beach
South Africa, Cape Town, Rear view of young couple sitting at beach. Tetra Images - Yuri Arcurs / Brand X Picture / Getty Images

The thing that makes sexually transmitted diseases unique is that they're spread through such intimate forms of contact. They're not the sort of condition you get from someone you work with or pass on the sidewalk. Instead, they're transmitted during various kinds of sexual activity. That means, for many people, the person who they are at most risk of infecting is the person to whom they're closest.

With the idea that most people know who they're having sex with, public health officials often attempt to engage in contact tracing when people are diagnosed with an STD. Unfortunately, many people aren't willing to disclose the names of, and contact information for, all their recent sexual partners. Others don't know them. Contact tracing is a great idea, but it's limited by stigma, shame, and even fear of intimate partner violence. That's where expedited partner therapy comes in.

Expedited partner therapy, or patient delivered partner therapy, is when a doctor prescribes STD treatment not just for their patient but for that patient's partner. It sounds straightforward, but it is remarkably controversial. There are significant ethical and practical concerns that have made expedited partner therapy quite difficult to implement in the US. These range from laws that prohibit doctors from prescribing medication to people who aren't their patients to concerns about antibiotic resistance if treatment is misused.

However, there has also been an additional question about expedited partner therapy ... does it work?

The answer seems to be yes, at least to a first approximation. A number of studies on expedited partner therapy have shown tentatively positive results. It is clear that expedited partner therapy increases the number of people receiving STD treatment.

It is less clear how that impacts the rate of STDs in the population as a whole. Still, the risk:benefit ratio for expedited partner therapy is a good one, at least in places where it's legal. Treatments for both chlamydia and gonorrhea, the STDs for which expedited partner therapy is most practical, are generally quite safe.

Interestingly, research suggests that a significant portion of the public is resistant to engaging in expedited partner therapy. Some people have good reasons, such as no longer being with their sexual partner or knowing that their partner has already been screened and treated. Others, however, simply aren't comfortable passing on the prescription to their partner or, possibly, talking about their diagnosis. Addressing those concerns will take some time, as will encouraging doctors to not just offer expedited partner therapy but also implement appropriate education on safe sex and prevention at the time of treatment.

Sources:

Cramer R, Hogben M, Handsfield HH. A historical note on the association between the legal status of expedited partner therapy and physician practice. Sex Transm Dis. 2013 May;40(5):349-51. doi: 10.1097/OLQ.0b013e3182853c61.

Cramer R, Leichliter JS, Stenger MR, Loosier PS, Slive L; SSuN Working Group. The legal aspects of expedited partner therapy practice: do state laws and policies really matter? Sex Transm Dis. 2013 Aug;40(8):657-62. doi:10.1097/01.OLQ.0000431358.18959.d4.

Golden MR, Kerani RP, Stenger M, Hughes JP, Aubin M, Malinski C, Holmes KK. 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. PLoS Med. 2015 Jan 15;12(1):e1001777. doi: 10.1371/journal.pmed.1001777

Introcaso CE, Rogers ME, Abbott SA, Gorwitz RJ, Markowitz LE, Schillinger JA. Expedited partner therapy in federally qualified health centers--New York City, 2012. Sex Transm Dis. 2013 Nov;40(11):881-5. doi: 10.1097/OLQ.0000000000000045.

Radovic A, Burstein GR, Marshal MP, Murray PJ, Miller E, Sucato GS. Adolescents' attitudes toward expedited partner therapy for sexually transmitted infections. Sex Transm Dis. 2013 Nov;40(11):894-7. doi:10.1097/OLQ.0000000000000034.

Vaidya S, Johnson K, Rogers M, Nash D, Schillinger JA. Predictors of index patient acceptance of expedited partner therapy for Chlamydia trachomatis infection and reasons for refusal, sexually transmitted disease clinics, New York City, 2011 to 2012. Sex Transm Dis. 2014 Nov;41(11):690-4. doi: 10.1097/OLQ.0000000000000197.

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