It is estimated that each year, there are almost 20 million new cases of sexually transmitted infections in the US, with 50% of these occurring among people aged 15-24. But a new study published in PLOS Medicine suggests a public health program encouraging the use of expedited partner therapy may be an effective way to reduce rates of these infections.
Expedited partner therapy (EPT) is the treatment of a sex partner of an individual diagnosed with a sexually transmitted infection (STI) without a health care provider examining the partner first.
Past studies have shown that EPT increases the rate of partner treatment and reduces the reinfection rates of chlamydia and gonorrhea – two of the most common STIs in the US.
The Centers for Disease Control and Prevention (CDC) also hail EPT as “a useful option to facilitate partner management, particularly for treatment of male partners of women with chlamydial infection or gonorrhea,” noting that the treatment “should be available to clinicians as an option for partner treatment.”
But despite the evidence of EPT’s effectiveness, the research team – including Matthew Golden of the University of Washington in Seattle – says the treatment has not been widely adopted in the US.
In their study, Golden and colleagues set out to see whether a public health program promoting EPT could increase treatment uptake and reduce infection rates of chlamydia and gonorrhea among women.
The researchers randomly assigned 23 of 25 local health jurisdictions in Washington to one of four groups. At 6-8 month intervals between October 2007 and August 2009, each group was required to initiate a public health program encouraging use of EPT.
Each public health program involved the offering of free EPT packs to clinicians in order to increase use of the therapy. The treatment packs were also made available through commercial pharmacies, allowing clinicians to prescribe the treatment to patients’ partners. Medical providers and clinic staff also received information on what the program was about.
Data on chlamydia and gonorrhea incidence was gathered from each group at the beginning and end of the public health program, while EPT uptake was assessed among randomly selected patients.
Golden and colleagues found that the proportion of patients receiving EPT from clinicians increased from 18.3% to 34% during each program, while the proportion of patients receiving EPT through commercial pharmacies rose from 25.2% to 44.9%. The incidence rates of both chlamydia and gonorrhea also fell during each program.
In addition, incidence of both chlamydia and gonorrhea reduced over the entire 22-month study period. The rate of chlamydia positivity among women aged 14-25 fell from 8.2% to 6.5%, while the annual incidence of gonorrhea reduced from 50.6 to 26.4 per 100,000 women.
The researchers estimate that the public health program initiated in this study was responsible for around 10% of the reduction in chlamydia and gonorrhea incidence. However, they say this finding is not statistically significant as the results are subject to several important limitations.
The team notes, for example, that the public health program may not have reached enough people with either of the two STIs. In addition, they say the program may have seeped into areas that were not studied, which may have influenced the results.
Still, the researchers say the uptake in EPT identified in this study is encouraging:
“We believe that our findings should promote increased efforts to expand the use of EPT. The effectiveness of EPT is supported by randomized trials demonstrating an individual-level benefit and by a cost-effectiveness analysis.
Our study showed that a public health intervention could lead to a very large increase in EPT use and, although not definitive, suggests that the increased use of EPT resulted in a modest decrease in population-level measures of gonorrhea and chlamydial infection in women.”
In June 2014, Medical News Today reported on a study suggesting that finding a partner via a phone app may increase the risk of STIs.