According to the Los Angeles County Department of Public Health, the number of sexually transmitted disease (STD) cases is increasing each year. In 2010, 44,648 case of chlamydia were reported and 10,401 cases of gonorrhea. To address the problem, which is growing nationwide, the American College of Obstetricians and Gynecologists (ACOG) released a new committee opinion on August 25, 2011; it noted that ACOG formally supports the use of expedited partner therapy (EPT) in the management of gonorrhea and chlamydia. The authors pointed out that in the U.S., women aged 15 to 24 years consistently have the highest rates of gonorrhea and chlamydia infections. The noted, “One of the contributing factors to these high rates is reinfection from an untreated sexual partner.” Statistics indicate that adolescent girls and young women have a 14- 26% incidence of reinfection within 12 months of an initial chlamydial infection. EPT is an approach that has been advocated to address the problem of reinfection. It involves healthcare providers giving prescriptions or medications to patients with the recommendation that they deliver them to their sexual partner or partners. EPT focuses on the concept that to minimize risk for reinfection, it is crucial that sexual partners be treated, even when the partner is unlikely or unable to come into the clinic for in-person evaluation and appropriate treatment. The authors noted that evidence indicates that EPT can decrease reinfection rates compared with standard partner referrals for examination and treatment; however, despite the demonstrated advantages of EPT over conventional care, there are numerous barriers (legal, medical, practical, and administrative) that may make healthcare practitioners leery of using that treatment approach.
Currently, EPT is permitted in 27 states (including California) and one city, “potentially allowable” in 15 states (including California), and prohibited in eight states. The U.S. Centers for Disease Control and Prevention (CDC) has endorsed the use of EPT and maintains a Web site that provides status updates on the legality of EPT in all 50 states. In addition to being wary of legal barriers, some clinicians avoid EPT because they are concerned that by skipping in-person exams of partners, they may miss spotting co-infections with other sexually transmitted diseases. Another concern is the potential for adverse reactions to the drugs; however, according to ACOG, the risk of serious adverse reactions after recommended antibiotic treatment of gonorrhea or chlamydial infection is relatively low, and can be further minimized by accompanying EPT with clear written instructions and printed information on contraindications and sources of care in case of adverse reactions.
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