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%

EPT Resources

http://www.cdc.gov/std/ept/