Expedited Partner TherapyThe Colorado Experience
Cornelis A. Rietmeijer, MD, PhD
Denver Public Health Department
Expedited Partner Therapy
• Approach whereby partners are treated without an intervening clinical assessment– Patients delivering medications to partners
– Patients delivering prescriptions to partners
– Field treatment by DIS or outreach workers (with or without testing)
EPT Studies• Schillinger et al. Sex Transm Dis 2003;30:49-56
– 20% reduction in CT re-infection of 20% among women (P = 0.102)
• Golden et al. New Engl J Med 2005;352:676-85
– 73% reduction in GC re-infection among men and women (P < 0.01)
– 17% reduction in CT re-infection (P = 0.17)
• Kissinger et al. Clin Infect Dis 2005; 41:623-9
– 46% reduction in GC and/or CT infection among men with urethritis (P<0.001)
EPT and the CDC 2006 STD Treatment Guidelines
• “….patient delivered therapy (i.e., via medications or prescriptions) can prevent re-infection of index case and has been associated with a higher likelihood of partner notification, compared with unassisted patient referral of partners”
• EPT recommendations are limited to GC and CT contacts only
• EPT is not recommended for MSM
In Colorado, EPT has been endorsed by the state’s medical
and pharmacy boards
EPT in Colorado
http://www.dora.state.co.us/Medical/policies/40-10.pdf
EPT in Colorado
www.dora.state.co.us/pharmacy/policies/40-4.pdf
EPT in the Denver STD Clinic
• Between 11/9/2006 and 2/28/2007–223 heterosexual patients with document GC
or CT eligible for EPT
–46 (20.6%) received EPT• Median: 1 Range: 1-3
–No demographic or risk differences between those who did or did not accept EPT
Partner Pack Chlamydia
EPT in the Denver STD Clinic
• Main reasons for not receiving EPT–Partners already treated or in clinic
concurrently (48.1%)
–Patients preferred partners come to the clinic (25.3%)
–No contact info (17.5%)
• Among clinicians, provision of EPT varied from 5% to 45%
