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Expedited Partner Therapy in Wisconsin

Expedited Partner Therapy in Wisconsin. STD Control Section Wisconsin Division of Public Health June 2010. Overview. Epidemiology of trichomoniasis , gonorrhea and Chlamydia trachomatis infections Partner Services Expedited partner therapy (EPT) EPT legislation in Wisconsin.

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Expedited Partner Therapy in Wisconsin

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  1. Expedited Partner Therapy in Wisconsin STD Control Section Wisconsin Division of Public Health June 2010

  2. Overview • Epidemiology of trichomoniasis, gonorrhea and Chlamydia trachomatis infections • Partner Services • Expedited partner therapy (EPT) • EPT legislation in Wisconsin

  3. Sexually Transmitted Diseases • In the Nation: • More than 1.5 million cases of gonorrhea and Chlamydia trachomatis infections were reported to the CDC in 2008 • Approximately 50% of new gonorrhea and Chlamydia trachomatis infections occurring each year remain undiagnosed and unreported • Trichomoniasis is the most common curable STD in young, sexually active women in the U.S., and an estimated 7.4 million new cases occur each year in both men & women

  4. Disease Cases Rate* Chlamydia 20,767 371 Gonorrhea 6,042 108 Syphilis 193 3 Total 27,002 482 * Cases per 100,000 population. Reported STD cases, by diseaseWisconsin, 2008 • In Wisconsin there are more bacterial sexually transmitted diseases (STDs) reported than all other reportable communicable diseases combined.

  5. Chicago Minneapolis Detroit STD Rates, Milwaukee, 2006: 2nd highest of 50 big cities in the U.S. Combined rates* for chlamydia, gonorrhea and primary and secondary syphilis for the 50 largest metropolitan areas, 2006, CDC data Milwaukee (2nd) * Cases per 100,000 population.

  6. Disproportionate Impact of STDs • For Example: • Adolescents • In Milwaukee, among adolescents 15-19 years of age, 1 in 18 were reported with a Chlamydia trachomatis infection and 1 in 50 with gonorrhea in 2008 • Communities of Color • The rate of reported STDs among black adolescents 15-19 years of age is 18 times that of whites in Wisconsin

  7. Complications of STDs • STDs cause at least 24,000 women in the U.S. each year to become infertile • Untreated trichomoniasis, gonorrhea and Chlamydia trachomatis infectionscan lead to: • Pelvic inflammatory disease (PID) • Ectopic pregnancy leading to fetal death • Infertility • Systemic infection of gonorrhea causing arthritis • Perinatal transmission leading to pneumonia or conjunctivitis • Increased risk of acquiring and transmitting HIV • Continued spread of infection

  8. Cost of STDs • STDs cost the U.S. health care system an estimated $15.9 billion annually • A single oral pill for treatment of Chlamydia trachomatis infection costs $30/patient while treatment for infertility can cost thousands of dollars per patient • A single oral pill for treatment of gonorrhea costs $19/patient while treating PID costs over $1000 per patient

  9. STD Re-infection is Common • Re-infection rates among women treated for CT1: • 15% re-infected within 6 months • 30% re-infected within 12 months • Re-infection rates among women treated for GC2: • 14% re-infected within 6 months • 27% re-infected within 12 months • Re-infection rates among men with CT & GC3: • 15% re-infected at 6 months • 21% re-infected at 8 months 1 Review of 17 active cohort studies 2 Review of 7 active and passive cohort studies 3 Fung et al, STI 2007

  10. Partner Services in Wisconsin • Local Health Officers are required to perform interviewing and investigation for cases of reportable STDs • A universally difficult task, sex partners are not always being notified and treated for STDs • Funding/staffing • Overwhelming burden of disease • Accuracy of sex partner information • Compliance of sex partners to seek medical attention • This is where EPT comes in . . .

  11. Expedited Partner Therapy • EPT is a treatment alternative for partners of a patient diagnosed with sexually transmitted diseases (STDs) without a medical evaluation of the partner • EPT allows the patient to deliver oral medication or prescriptions to their sexual partner who might not otherwise seek care • EPT prevents re-infection to the original patient, thus reducing the burden of STDs in the community

  12. Summary of CDC’s Guidance for Expedited Partner Therapy in the Management of Sexually Transmitted Diseases • EPT was effective in reducing persistent or recurrent infections due to chlamydia and gonorrhea • EPT was associated with higher likelihood of partner notification and partner treatment • Preliminary economic analysis suggest that EPT is a cost-saving and cost-effective partner management strategy • EPT represents an additional strategy for partner management that does not replace other strategies

  13. Nationally: CDC American Medical Association Society of Adolescent Medicine National Association of County and City Health Officials The Council of State Governments The National Bar Association 22 states including Minnesota, Illinois, and Iowa In Wisconsin: The Department of Health Services Medical Examining Board Medical Society of WI WI Academy of Family Physicians American College of Nurse-Midwives WI Nurses Association Wisconsin Public Health Association Planned Parenthood EPT is supported by:

  14. 2009 EPT Legislation in Wisconsin • Explicitly allows medical providers to dispense medication or prescribe EPT and pharmacists to dispense medication • Limits liability for all providers as long as EPT is provided in accordance with the Act • Allows the prescription to be written for “EPT” when the patient does not know or is unwilling to give the partner’s name • Requires written materials be developed by DHS and be provided with EPT prescription about trichomoniasis, gonorrhea and Chlamydia trachomatis infections, their treatment and the risk of drug allergies

  15. Current Status of Legislation in Wisconsin • Act 280 was signed into law by Governor Doyle on May 11, 2010 • Effective May 26, 2010 • The Act requires written materials (an ‘information sheet’) be distributed to the patient by the medical provider, for use by the partner receiving EPT.

  16. Information Sheet • The Information Sheet distributed by the clinician to the patient, for the sex partner receiving treatment shall include: • Information about STDs and their treatment • The risk of drug allergies from the treatment • A statement advising persons with questions to contact his/her physician, pharmacist, or local health department

  17. Coming Soon . . . EPT Provider Guidance – specific information on EPT for medical providers FAQ sheet for local health departments, medical providers, and pharmacists

  18. Please visit the Wisconsin STD Control Section website for implementation materials at: http://dhs.wisconsin.gov/communicable/STD/INDEX.HTM or call 608-266-7365 For further information visit: www.cdc.gov/std/EPT

  19. Questions? For more information or questions regarding EPT legislation please contact Marisa Stanley at 608-266-0463 or marisa.stanley@wi.gov For questions regarding the STDs and implications of EPT for health departments please contact, Loriann Wunder at 608-266-7922 or loriann.wunder@wi.gov

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