For Physicians. By Physicians.™
For Physicians. By Physicians.™
The sex partners of persons with sexually transmitted infections (STIs) require treatment. This treatment has been a central component of prevention and control of bacterial STIs in the United States for decades. Traditionally, it has been left to patients or health care providers to notify partners of infected persons of their exposure to an STI. Common practice is to inform, evaluate and treat sex partners of persons infected with STIs. Partner management arose from the campaign to control syphilis and ultimately, congenital syphilis. Now partner management has become widely recommended for gonorrhea, chlamydial infection and, most recently, human immunodeficiency virus (HIV) infection. However, for STIs other than syphilis, partner management based on provider referral is rarely assured, while patient referral has had only modest success in assuring partner treatment.
An alternative approach to assuring treatment of partners is expedited partner therapy (EPT). EPT is the delivery of medications or prescriptions by persons infected with an STI to their sex partners without clinical assessment of the partners. Clinicians ranging from physicians to public health workers give the infected persons sufficient medications directly or a prescription for the patients and their partners. Following an evaluation of medical studies on EPT, the CDC concluded that EPT is a “useful option” to further partner treatment, particularly for male partners of women with chlamydia or gonorrhea. In August 2006, CDC recommended this practice for certain populations and specific conditions and CDC continues to recommend it in Sexually Transmitted Diseases Treatment Guidelines, 2010.
Throughout discussions of EPT, the legal status of the practice remained a gray area. Therefore, CDC collaborated with two public health centers to assess the legal framework concerning EPT across all 50 states and other jurisdictions (the District of Columbia and Puerto Rico). Assessment of local statutes excluding the District of Columbia and tribal laws for sovereign nations was not undertaken.
The CDC’s EPT Legal Status color-coded map shows the states and jurisdictions where EPT is allowable or potentially allowable. Of note, this map also shows those states where EPT is prohibited. The most cited reason is that a physician patient relationship is required. The relationship could require a physical exam, discussion with the patient, or availability for follow-up.
Expedited partner therapy is recommended only after an obstetrician–gynecologist or other provider has assessed the risk of intimate partner violence associated with partner notification. It is not intended for use in cases of suspected child abuse, sexual assault, or any other situation in which the patient’s safety from her abuser may be compromised.
ACOG Committee Opinion 737: Expedited Partner Therapy
Color-coded map: Legal Status of Expedited Partner Therapy (EPT)
Perspectives on expedited partner therapy for chlamydia: a survey of health care providers.
Expedited Partner Therapy: Clinical Considerations and Public Health Explorations
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