1020 Effectiveness of chlamydia expedited partner therapy in pregnancy

Abstract

Expedited partner therapy (EPT) for chlamydia trachomatis (CT) is recommended to reduce reinfection in a gynecologic population. Little data exist on the effectiveness of EPT in a pregnant population at risk for adverse outcomes. We evaluate the real-world effectiveness of an EPT program in eradicating CT before delivery. An EPT program was implemented on August 21, 2019 at a high-prevalence county hospital. Pregnant women were provided with single-dose packets of azithromycin to treat partner(s) following diagnosis of CT. We prospectively studied pregnant women treated in the EPT program who delivered at our institution in the same year and compared outcomes to a historical cohort from the year prior. We excluded women with concurrent gonorrhea, HIV, syphilis, or history of domestic violence. The primary outcome was CT reinfection or failed treatment at repeat testing 4-6 weeks following treatment. Secondary outcomes included obstetric outcomes and neonatal outcomes. Assuming a 30% reinfection rate, to detect a 50% reduction in reinfection with 90% power, 266 women were needed in each group. Student’s t-test and Chi-squared tests were used for statistical analysis, with a p-value <0.05 considered significant. In the year following implementation of EPT, 471 women diagnosed with CT delivered at our institution, compared with 420 pre-EPT (Table 1). There were no differences in maternal characteristics or gestational age at presentation. Compared to the pre-EPT group, the frequency of reinfection in the post-EPT group was not statistically different (60/471 (13%) vs 61/420 (15%), OR 1.16 (95%CI 0.79, 1.71)). In a per-protocol analysis, 72 (17%) of pre-EPT and 388 (82%) of post-EPT groups actually received EPT; reinfection was not statistically different between groups (p=0.45). There were no differences in secondary outcomes (Table 2). Implementation of a prenatal EPT program did not significantly affect the frequency of chlamydia reinfection before delivery. Future efforts include exploring patient education and safe sex practices beyond EPT alone.View Large Image Figure ViewerDownload Hi-res image Download (PPT)