Expedited partner therapy could help couples get the antibiotics they need for STD treatment, but there are still obstacles to overcome to make it happen.
In 2017, there were about 2.3 million new cases of STDs in the U.S. Even though the infection rates for gonorrhea and chlamydia hit records, only the patient seeking the treatment could get the medication they need, which meant their partner had to seek their own treatment or the patient could become infected again.
The Centers for Disease Control and Prevention recommended the expedited partner therapy approach to combat the STD epidemic. In many states, doctors are allowed to write prescriptions for a person’s partner even if only one person was diagnosed with the disease. These states’ laws permit pharmacies and clinics to give STD drugs to partners of those infected.
Three University of Michigan physicians talk about the obstacles people have when it comes to expedited partner therapy. If the obstacles were to be overcome, more STD cases could be prevented including potential reinfections of those that have already sought treatment.
Many well-known and lesser-known medical societies have encouraged the EPT practice based on the fact that it’s both safe and effective. However, it’s a technique that’s still not widely utilized.
Dr. Cornelius Jamison, team leader behind the report, said EPT is a public health issue where public policy is gaining on clinical practice. Jamison is currently leading research that’s looking into the obstacles that stop clinics from implementing and using the EPT method.
Jamison said the entire health community needs to have some general understanding of what the EPT is, how it works and what it would take for the method to become widely accepted and used.
The paper offers a theoretical framework that lays out every possible obstacle for using EPT – a framework that could guide work that lays out how to overcome the obstacles.
When it comes to EPT, there are several barriers that relate to the disease nature and the stigma of an STD infection. These barriers could keep teenagers and young adults from getting tested for STDs and get treatment for fear of their parents finding out through bills, insurance records and positive test results.
Jamison said many patients will get tested and/or treatments from a walk-in clinic that is cash-only or free. These sites are necessary for boosting EPT use. On top of that, their partners may have no insurance or want to use their insurance to pay for the STD tests or treatments.
Jamison said if STD positive patients are given a pack of EPT antibiotics or a pre-written prescription, it could help them overcome the obstacles.
Gonorrhea and chlamydia drugs tend to be prescribed together for people who test positive for even just one infection. A doctor may prescribe their patients with Suprax and Zithromax.
EPT medication costs can differ from one place to another, but even if the cost is low, teenagers and low-income individuals may have a hard time paying for the prescriptions.
There are multiple guidelines that suggest any sexually active teen and young women should get tested for gonorrhea and chlamydia annually. Some recommendations suggest older women also get tested. With inconsistent screenings, it means infections will run rampant and lead to further complications such as infertility, higher chance for HIV infections in women and pelvic inflammatory disease.
With more screenings and treatment, it means providers have a better chance of talking to patients with STDs about why they need to get their partner STD-treatment drugs. With a rise in more screening and treatment opportunities, it means doctors can talk to STD positive patients on why they need to get antibiotics for their partners and use safe sex practices during sexual activity.
While many EPT clinical barriers remain, it’s also the legal issues that hinder EPT. For example, seven states, as well as Puerto Rico, have unclear laws regarding EPT. Both Kentucky and South Carolina do not permit EPT.
Another problem is the reluctance pharmacists and physicians have in offering EPT to patients because of a liability that could result if an EPT recipients were to experience any side effects even with states that permit the EPT practice.
Jamison’s research is looking at EPT and its usage in federal-mandated health clinics where any patient, no matter if they have insurance or not, can pay. He said more information is needed in using and prescribing EPT in all areas, with certain steps being implemented so clinics could ensure EPT is given to the right patients.
Jamison said it’s important to determine what that right thing is for STD patients.
Written by Mark Riegel, MD
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