DC American Academy of Pediatrics Adolescent Health Working Group

1. DC American Academy of Pediatrics Adolescent Health Working Group Expedited Partner Therapy Fact Sheet Updated February 20, 2014 What is Expedited Partner Therapy? Expedited Partner Therapy (EPT) is the clinical practice of treating the sex partners of patients diagnosed with a sexually transmitted infection (e.g. Chlamydia, Gonorrhea, Trichomoniasis) by providing prescriptions or medications to the patient to take to his/her partner without the health care provider first examining the partner (CDC, 2013). The usual method of delivery is via patient-delivered partner therapy (PDPT), whereby clinicians provide their patients (index patient) with medications intended for their partners. This can be done by writing prescriptions in the partners’ names, or by prescribing additional doses of medication in the index patients’ names. The Centers for Disease Control and Prevention’s (CDC) 2010 Sexually Transmitted Disease Treatment Guidelines recommend the use of EPT when patients indicate their heterosexual partners are unlikely to seek medical evaluation and treatment. Professional organizations such as the American Academy of Pediatrics (2009), American Medical Association (2008), American College of Obstetricians and Gynecologists (2011), American Academy of Family Physicians (2012), Society for Adolescent Medicine (2009), and American Bar Association (2008) have endorsed EPT. Is EPT legal in DC? DC Bill 20-343, the “Expedited Partner Therapy Act of 2013” permits health care practitioners to prescribe prescription drugs without an examination to the partners of a patient diagnosed with Chlamydia, Gonorrhea, or Trichomoniasis. The DC City Council unanimously approved the bill on January 7, 2014, with mayoral approval pending. Is EPT recommended for treating adolescents with STIs? While in person treatment is always preferable because it provides an opportunity for more in depth screening and counseling, providers should be aware that adolescents with STIs are at high risk of reinfection from untreated partners. Providers who care for adolescents should consider EPT for Chlamydia- or Trichomonas-infected heterosexual males and females whose partners are unlikely or unable to otherwise receive treatment. Current CDC guidelines do not recommend oral treatment for Gonorrhea. The recommended treatment for Gonorrhea is ceftriaxone 250 mg intramuscularly along with a single dose of oral azithromycin 1 gm or doxycycline100 mg orally twice a day for 7 days. The CDC indicates that EPT for Gonorrhea with oral cefixime and azithromycin should be considered only when partners of patients cannot seek timely treatment, as not providing treatment would be significantly more harmful than providing EPT for Gonorrhea. If oral cefixime is used, a test of cure should be conducted 1 week after treatment. Bacterial culture is the preferred method of test of cure because it can be followed with antibiotic sensitivity testing if positive. DC American Academy of Pediatrics Adolescent Health Working Group EPT Fact Sheet February 20, 2014

2. Is EPT effective? Clinical and behavioral outcomes based on the results of four randomized control trials (RCTs) funded by the CDC indicate that EPT is an effective tool to reduce rates of STI (CDC, 2006). Are there any areas of concern associated with EPT? Some of the issues to consider include the information provided by the index patient about the partner may not be known or inaccurate, and there is the possibility of co-morbid infections that may not be detected or treated, including PID and HIV. As noted earlier in this document, the current recommended treatment by the CDC for Gonorrhea is ceftriaxone 250 mg intramuscularly along with a single dose of oral azithromycin 1 gm or doxycycline100 mg orally twice a day for 7 days and EPT for Gonorrhea with oral cefixime and azithromycin should be considered only when partners of patients cannot seek timely treatment, as not providing treatment would be significantly more harmful than providing EPT for Gonorrhea. What are the implications for health care providers? Once DC B20-343 is enacted, health care providers in DC may provide EPT and must designate “EPT” in the body of the prescription; if the sexual partner’s name, address, and date of birth are not available, the written designation “EPT” will be sufficient for the pharmacist to fill the prescription. Along with the prescription, the prescriber must provide informational materials on: the possible side effects of the medication, STI prevention, and steps to minimize disease transmission. They must also report to the Department of Health the number of expedited partner prescriptions they issue along with the previously required reportable patient information. Further, providers should provide written warnings regarding precautions if the partner may be pregnant or may have an allergy to the medication, and information about the importance of seeking medical treatment- with warning signs for suspecting PID as well as information about available sites to receive medical care. • References • American Academy of Pediatrics (2009). Statement of Endorsement—Expedited Partner Therapy for Adolescents Diagnosed With Chlamydia or Gonorrhea. Pediatrics, 124(4), 1264. Retrieved from http://pediatrics.aappublications.org/content/124/4/1264.full. • American Bar Association (2008). Recommendation No. 116A. Adopted by the House of Delegates August 11-12, 2008. Retrieved from http://www.americanbar.org/content/dam/aba/directories/policy/2008_am_116a.authcheckdam.pdf. • American College of Obstetricians and Gynecologists (2011). Expedited Partner Therapy in the Management of Gonorrhea and Chlamydia by Obstetrician-Gynecologists. Committee Opinion No. 506. ObstetGynecol 118, 761–766. Retrieved from http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Adolescent_Health_Care/Expedited_Partner_Therapy_in_the_Management_of_Gonorrhea_and_Chlamydia_by_Obstetrician-Gynecologists. • American Medical Association (2008). Opinion 8.07 - Expedited Partner Therapy. Retrieved from http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion807.page. • Burstein, G. R., Eliscu, A., Ford, K., Hogben, M., Chaffee, T., Straub, D., ... & Huppert, J. (2009). Expedited partner therapy for adolescents diagnosed with Chlamydia or Gonorrhea: a position paper of the Society for Adolescent Medicine. Journal of Adolescent Health, 45(3), 303-309. doi: 10.1016/j.jadohealth.2009.05.010. • Centers for Disease Control (2013). Expedited Partner Therapy. Retrieved from http://www.cdc.gov/std/ept/default.htm. • Centers for Disease Control (2006). Expedited Partner Therapy in the Management of Sexually Transmitted Diseases. Retrieved from http://www.cdc.gov/std/treatment/EPTFinalReport2006.pdf. DC American Academy of Pediatrics Adolescent Health Working Group Expedited Partner Therapy Fact Sheet February 20, 2014