Tuesday, May 23, 2006

DSHS endorses expedited partner therapy

The latest issue of the Texas HIV/STD e-Update includes the following news:

The Texas Department of State Health Services (DSHS) has issued a position paper supporting the use of Expedited Partner Therapy (EPT) as a valuable strategy for reducing STD morbidity in Texas.

EPT is the practice of treating the sex partners of persons with an STD without an intervening medical evaluation or professional prevention counseling of the partner. The usual implementation of EPT is through patient-delivered partner therapy (PDPT), although other methods may be employed.

With patient-delivered partner therapy (PDPT), clinicians provide their patients with drugs intended for the partners, prescribe extra doses of medication in the index patients’ names, or write prescriptions in the partners’ names. The available evidence indicates that Expedited Partner Therapy is at least equivalent in efficacy to standard partner management for gonorrhea and chlamydia infection; that traditional partner management by public health agencies and health care providers for these STDs is limited in scope; and that the benefits of EPT outweigh the risks. Therefore, EPT should be available to clinicians as an option for partner management for gonorrhea and chlamydia infection.

In Texas, as in the U.S, emerging data indicate that many providers selectively employ EPT for gonorrhea and chlamydia infection and that some do so routinely. Disease Intervention Specialists (DIS) deliver medications in the field as part of STD public health follow-up. Clinicians should strongly consider EPT as an important and useful option for facilitating partner treatment of sexually transmitted diseases.

I have not yet located the DSHS position paper. The full CDC recommendation can be found at: www.cdc.gov/std/treatment/EPTFinalReport2006.pdf. The CDC recommends EPT for the heterosexual partners of males and females with gonorrhea and chlamydia (accompanied by additional counseling through written educational materials or by health professionals, e.g., pharmacists). The CDC does not recommend RPT for persons infected with syphilis or for the partners of men who have sex with men. In the latter case, the additional risk of co-infection with HIV is high enough to warrant referral to a physician for diagnosis and treatment; EPT should only be used if such referral is "impractical or unsuccessful."

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