The Use of Expedited Partner Therapy (EPT) to Reduce Sexually Transmitted Infections in Colorado
In response to the recommendations and barriers related to use of EPT, the Colorado Department of Public Health and Environment Sexually Transmitted Infection/HIV Section staff have assembled information about the use of EPT in Colorado to assist health departments, public and private healthcare providers and others in exploring the implementation of EPT as a partner management strategy.
Types of partner management strategies for patients diagnosed with a sexually transmitted infection (STI) include provider referral (in which the health department or provider notifies a partner of an STI exposure with or without the assistance of the original patient) and patient referral (in which the original patient attempts to assure his/her partner receives appropriate medical
In spite of identified and perceived barriers to implementing EPT, expedited partner therapy is legal in Colorado, and the Colorado Department of Public Health and Environment encourages healthcare providers to address and overcome these barriers to EPT to reduce the burden of STI in Colorado.
Kelly O’Keefe Voorhees, MSPH
STI/HIV Section, Disease Control and Environmental Epidemiology Division
Colorado Department of Public Health and Environment
As a means to assure that exposed partners are adequately treated, health departments and providers in many areas are practicing expedited partner therapy (EPT) by which partners of STI patients are treated without an examination and without counseling messages. Among EPT practices, some providers are utilizing patient-delivered partner therapy (PDPT) in which patients diagnosed with STI deliver medications to their partners. To encourage more widespread consideration of these partner management options, the CDC published its 2006 guidance report, Expedited Partner Management in the Treatment of Sexually Transmitted Diseases.
The guidance summarized evidence based on the results of four randomized controlled trials (RCT) for the efficacy of EPT in preventing recurrent chlamydia and gonorrhea infections after initial treatment and in assuring that partners are notified and receive treatment. Additionally, the RCT demonstrated that EPT was associated with a decreased likelihood that a patient would have sex with an untreated partner. The following salient findings related to EPT are found within the CDC guidance:
The CDC has been joined by the American Medical Association in recommending that EPT be considered and implemented as a partner management strategy. (Region VIII Infertility Prevention Project)
Centers for Disease Control and Prevention. Expedited Partner Therapy in the Management of Sexually Transmitted Diseases. Atlanta, GA: US Department of Health and Human Services, 2006.
A number of barriers remain to be addressed in assuring more widespread and consistent use of expedited partner therapy (EPT). A 2005 survey of various clinical sites in the Region VIII Infertility Prevention Project2 identified a number of these barriers including:
Additional barriers to EPT have also been cited. Similar to situations involving more traditional Disease Intervention Specialist (DIS)-mediated partner notification, a diagnosed patient may refuse to deliver medications or a prescription to a partner because the patient: 1) does not know or has no locating information for the partner; 2) does not like the partner; or 3) is afraid of the partner.
EPT may also be resisted because it is seen as a missed opportunity to test for other STI and to provide counseling messages to an exposed partner. Although the risk of adverse reactions to therapy has been shown to be low, providers may be reluctant to tolerate even a low risk given possible legal and medical ramifications of an adverse event. Additionally, EPT is not feasible in many settings because of operational barriers, including the lack of clarity regarding the legality of practicing EPT in many states. (Region VIII Infertility Prevention Project)
2The 2005 EPT survey obtained data from IPP sites located in Colorado, Montana, and South Dakota. The survey was designed to identify how often EPT was being practice, the circumstances when EPT was practiced, barriers to implementing EPT, and what clinics would need to implement EPT as a more standard practice. One community health center, five STI clinics, and over twenty-four family planning clinics provided survey information.
From The Centers for Disease Control and Prevention. Expedited Partner Therapy in the Management of Sexually Transmitted Diseases. Atlanta, GA: US Department of Health and Human Services, 2006.
Expedited Partner Therapy (EPT) is at least equivalent to patient referral in preventing persistent or recurrent gonorrhea or chlamydial infection in heterosexual men and women, and in its association with several desirable behavioral outcomes. These conclusions support the following recommendations:
To support health departments, public and private healthcare providers and others in exploring
STI/HIV Client-Based Prevention Program
The Client Based Prevention Services program provides statewide follow-up to ensure persons infected with, or at high risk for, STD and HIV receive test results, treatment, risk-reduction counseling, referrals, partner notification services, and prevention case management for HIV infected/affected individuals. The program provides additional activities including public information, selected group level interventions, client satisfaction assessment and advocacy to improve services and referrals and decrease disease transmission and content expertise and preceptorships.
What It Does
Provides highly focused statewide outreach with STD and/or HIV infected and exposed persons, technical assistance, capacity building for and oversight of Partner notification (PN) services.
Whom the Program Serves
Office Phone Numbers:
To treat, control, and prevent the spread and complications of Sexually Transmitted Diseases (STD) including HIV and other designated diseases that are transmitted sexually or through intravenous drug use.
CRS 25-4-1401 et seq (HIV/AIDS); CRS 25-4-4 et seq (STD); CRS 25-1-122 (Communicable diseases); CRS 25-1-107 (Communicable diseases); CRS 19-3-304 (Child abuse reporting by CDPHE). The full text of these statutes is available at the Colorado Department of Public Health and Environment regulations.