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Expedited Partner Therapy to Treat Persons Exposed to Chlamydia

A person writing Chlamydia on a white boardNYSDOH Position Statement

Chlamydia is a leading cause of pelvic inflammatory disease (PID), ectopic pregnancy, and infertility. People with untreated chlamydia may also be at increased risk for acquiring or transmitting HIV. Many people experience multiple episodes of chlamydia re-infection soon after treatment, often due to lack of adequate treatment in their sexual partner(s).

To prevent reinfection, minimize complications in individuals, and reduce transmission in the community, partners of patients with chlamydia must be provided timely and appropriate antibiotic treatment. Chlamydia is the most commonly reported communicable disease in the state, with over 110,000 diagnoses each year. Individualized public health follow-up for every case is impractical for most areas.

Expedited Partner Therapy (EPT) is the clinical practice of providing individuals with chlamydia medication or a prescription to deliver to their sexual partner(s) as presumptive treatment for chlamydia, without completing a clinical assessment of those partners. Randomized controlled trials have found that this strategy decreases rates of chlamydia reinfection among index patients and increases the proportion of sex partner(s) reported to be treated for chlamydia.(1,2) The Centers for Disease Control and Prevention, along with several national professional organizations, recommend EPT as an effective and practical strategy for treating the sex partners of people with chlamydia. (3-7)

The New York State Department of Health (NYSDOH) strongly encourages providers to utilize EPT as a strategy to treat the sex partner(s) of persons diagnosed with chlamydia.111111 Additionally:
  • EPT for chlamydia is authorized under New York Codes, Rules, and Regulations (NYCRR) section 23.5, of Title 10, and Section 2312 of NYS Public Health Law.(8,9) Health care providers or pharmacists who administer EPT in accordance with this law are not subject to civil or criminal liability and will not be deemed to have engaged in professional misconduct as a result of this strategy.
  • EPT should not be provided for any partner(s) when the index patient with chlamydia is co- infected with gonorrhea, syphilis, and/or HIV. Treatment for chlamydia alone is not adequate to treat these other infections.
  • EPT may not be clinically appropriate for every patient. For example, EPT is not recommended for gay, bisexual, and other men who have sex with men due to the lack of study data on EPT’s effectiveness in this population and the risk of STI/HIV co-infection among partners.(10)
  • EPT medication may be provided directly to the index patient to deliver to their sex partner(s). This approach is preferred to a written prescription because prescriptions may introduce barriers to accessing EPT such as transportation, cost, and/or confidentiality. Providing medication directly to the index patient may also be more convenient for providers.
  • EPT prescriptions are currently waived from the NYS electronic prescription (“e-prescribe”) mandate. A blanket waiver letter of the electronic prescribing requirements is available at: https://www.health.ny.gov/professionals/narcotic/electronic_prescribing/docs/2018-06- 06_blanket_waiver_letter.pdf. Paper prescriptions may be used for EPT. Providers may order prescription pads at: https://www.health.ny.gov/forms/doh-250.
  • As stated in NYCRR §23.5,8 health education materials must be distributed when providing EPT (medication or prescription). EPT health education materials may be ordered from NYSDOH at: https://www.health.ny.gov/forms/order_forms/ept.htm.
  • The New York City Department of Health and Mental Hygiene produces EPT-related health education materials available at: https://www1.nyc.gov/site/doh/providers/health-topics/expedited-partner-therapy.page.
  • Severe adverse reactions such as anaphylaxis are extremely rare with azithromycin. Milder side effects which may impact the success of treatment, including nausea and vomiting, occur in fewer than five percent of patients.(11)
  • Additional EPT guidelines, resources, and information are available at: https://www.health.ny.gov/diseases/communicable/std/ept/index.htm.

References: 
(1) Shiely F, Hayes K, Thomas KK, et al. Expedited Partner Therapy: A robust intervention. Sex Transm Dis. 2010:1. doi:10.1097/olq.0b013e3181e1a296.
(2) Golden MR, Whittington WL, Handsfield HH, et al. Effect of expedited treatment of sex partners on recurrent or persistent gonorrhea or chlamydial infection. N Engl J Med. 2005;352(7):676-685. doi:10.1056/nejmoa041681.
(3) Centers for Disease Control and Prevention. Expedited Partner Therapy in the Management of Sexually Diseases: Review and Guidance. Atlanta, GA: US Department of Health and Human Services, 2006. https://www.cdc.gov/std/treatment/eptfinalreport2006.pdf. Accessed October 30, 2018.
(4)American Bar Association. Recommendation No. 116A. Adopted by the House of Delegates August 11-12, 2008. Chicago (IL): ABA; 2008. Available at: http://www.americanbar.org/content/dam/aba/directories/policy/2008_am_116a.authcheckdam.pdf. Retrieved October 30, 2018.
(5) ACOG Committee Opinion No. 737. Obstet Gynecol. 2018;131(6). doi:10.1097/aog.0000000000002621.
(6) American Medical Association. Expedited partner therapy. In: Code of medical ethics of the American Medical Association: current opinions with annotations. 2014-2015 ed. Chicago (IL): AMA; 2015. p. 274–5.
(7) Burstein GR, Eliscu A, Ford K, et al. Expedited Partner Therapy for adolescents diagnosed with chlamydia or gonorrhea: A position paper of the Society for Adolescent Medicine. J Adolesc Health. 2009;45(3):303-309. doi:10.1016/j.jadohealth.2009.05.010.
(8) New York State Codes, Rules, and Regulations Title 10, Section 23.5 - Expedited partner therapy for chlamydia trachomatis infection. Available at: https://regs.health.ny.gov/content/section-235-expedited-partner-therapy-chlamydia-trachomatis-infection
(9) New York State Public Health Law Section 2312—Expedited partner therapy for chlamydia trachomatis infection. Available at: http://public.leginfo.state.ny.us/lawssrch.cgi?NVLWO:
(10) Health.ny.gov. Expedited Partner Therapy Guidelines for Health Care Providers in NYS for Chlamydia trachomatis. Available at: https://www.health.ny.gov/diseases/communicable/std/ept/guidelines_for_providers.htm.
(11) Rubinstein E. Comparative safety of the different macrolides. Int J Antimicrob Agents. 2001;18:71-76. doi:10.1016/s0924-8579(01)00397-1.
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