Abstract
BackgroundExpedited Partner Therapy (EPT) has been shown to improve treatment outcomes among heterosexual partners of individuals with curable sexually transmitted infections (STIs). Although the use of EPT with men who have sex with men (MSM) has been debated, due to the potential for missed opportunities to diagnose unidentified cases of HIV and syphilis infection in symptomatic partners, increases in partner notification (PN) resulting from use of EPT may promote testing and treatment of otherwise unidentified partners. We assessed the impact of EPT on self-reported PN among MSM in Peru with gonorrheal (GC) and/or chlamydial (CT) infection.MethodsWe enrolled 173 MSM in Lima, Peru with symptomatic or asymptomatic GC and/or CT infection between 2012 and 2014. We enrolled 44 MSM with symptomatic urethritis/proctitis and 129 MSM with asymptomatic GC/CT infection, diagnosed based on nucleic acid testing (Aptima Combo 2 Transcription-Mediated Amplification [TMA]) from urethral, pharyngeal, and rectal sites. Eligible participants were randomly assigned to receive either standard PN counseling (n = 84) or counseling plus EPT (cefixime 400 mg/azithromycin 1 g) for up to five recent partners (n = 89). Self-reported notification was assessed by computer-assisted self-administered survey among 155 participants who returned for 14-day follow-up.ResultsThe median age of participants was 26 (interquartile range [IQR]: 23–31) with a median of 3 sexual partners (IQR: 2–4) in the previous 30-day period. Among all participants, 111/155 (71.6%) notified at least one partner at 14-day follow-up with a median of 1 partner notified per participant (IQR: 0–2). For participants randomized to receive EPT, 69/83 (83.1%) reported notifying at least one partner, compared with 42/72 (58.3%) of participants in the control arm (odds ratio = 3.52; 95% confidence interval [CI]: 1.68–7.39). The proportion of all recent partners notified was significantly greater in the EPT than in the control arm (53.5%, 95% CI: 45.0–62.0% versus 36.4%, 95% CI: 27.0–47.4%).ConclusionsProvision of EPT led to significant increases in notification among Peruvian MSM diagnosed with GC/CT infection. Additional research is needed to assess the impact of EPT on biological outcomes, including persistent or recurrent infection, antimicrobial resistance, and HIV/STI transmission, in MSM sexual networks.Trial registrationClinicalTrials.gov, NCT01720654. Registered on 10/29/2012.
Highlights
Expedited Partner Therapy (EPT) has been shown to improve treatment outcomes among heterosexual partners of individuals with curable sexually transmitted infections (STIs)
Symptomatic urethritis and/or proctitis was noted in 44 participants, and asymptomatic, laboratory-diagnosed infection was present in 232 (13 participants diagnosed with symptomatic urethritis/proctitis subsequently tested negative for GC/CT infection by TMA)
In our trial of EPT for Peruvian men who have sex with men (MSM) newly diagnosed with GC/CT infection, patient-delivered partner therapy was associated with an increase in self-reported partner notification and in HIV/STI prevention outcomes across all partnership types
Summary
Expedited Partner Therapy (EPT) has been shown to improve treatment outcomes among heterosexual partners of individuals with curable sexually transmitted infections (STIs). The use of EPT with men who have sex with men (MSM) has been debated, due to the potential for missed opportunities to diagnose unidentified cases of HIV and syphilis infection in symptomatic partners, increases in partner notification (PN) resulting from use of EPT may promote testing and treatment of otherwise unidentified partners. Expedited Partner Therapy (EPT) provides an opportunity for the targeted delivery of sexually transmitted infection (STI) control interventions to high-risk sexual partnerships and networks. By providing antibiotic therapy to the recent partners of STI-positive index patients, either through patient delivery or alternate methods of expedited access without a prescription, EPT removes key institutional and interpersonal barriers to treatment [1,2,3]. Lingering questions concerning the use of EPT with sexual partners of men who have sex with men (MSM) have discouraged regular use of EPT in this population
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