Expedited partner therapy for sexually transmitted diseases--are we there yet?

Abstract

Repeat STIs cause a significant amount of reproductive morbidity and an important percentage of repeat infections are caused by re-infection from untreated sex partners.1 Expedited partner therapy (EPT), or the provision of medicine to a sex partner of a persons infected with an STI without the requirement of a clinical exam, was conceived to accelerate and facilitate partner treatment, thus reducing the chance of re-infection to the index person. EPT was endorsed by the Centers for Disease Control and Prevention (CDC) in 2006 as a useful option for partner management for selected STDs among heterosexuals. To date, at least 26 RCTs have been conducted to evaluate EPT. A recent meta-analysis of these RCTs found that EPT reduced repeat infections by 20–29% depending on the STD and the demographics of the index person and resulted in more partners being treated when compared to standard partner referral by the index patient.2 So there is good evidence that, in randomized trials, EPT is efficacious for reducing repeat STIs. In this edition of Sexually Transmitted Diseases, Vaidya et al. evaluated acceptance of patient-delivered partner therapy (PDPT), a form of EPT, in New York City STD clinics.3 Their findings were highly encouraging, in that, under the best circumstances (i.e. when legal, with funding, when offered by the provider) half of eligible index patients accept PDPT to bring to their sex partners. And for the majority of those who don’t accept, their reason for not accepting was that either their partner had already been treated or the partner was no longer accessible to the index person. So in essence, most partners who could or should get EPT, likely got it. This adds to the growing literature indicating that index patients will accept EPT if offered.4–6 The situation in NYC is a great model for how EPT could work. Unfortunately, in many parts of the U.S., EPT is still not widely used because of barriers that are further upstream in the EPT cascade such as legality, funding, policy and provider reticence. The cascade depicted in Figure 1 shows the steps that are needed for the partner to actually get treated via EPT. These steps are discussed below. Figure 1 EPT cascade