Expedited Partner Therapy for Adolescents Diagnosed with a Sexually Transmitted Infections

Posted by Joelle Simpson MD

SCENARIO:
Resident: I have a 16 yo female who came in because she said she got a call from us that she was positive for Chlamydia. She had not gotten treated, so I was going to write her for treatment
Me: Sounds good
Resident: She asked me for a prescription for her boyfriend. Can I give her one even if he is not here? I can call him.
Me: uhmmmm …I’m not sure I am comfortable prescribing for someone I’ve never seen – I am not sure what the rules are for DC  – let me look into it ….

QUESTION:  Does the article below help your decision making for this scenario? (Post your comments below)

Expedited Partner Therapy for Adolescents Diagnosed with Chlamydia and Gonorrhea: A Position paper for the Society of Adolescent Medicine. Journal of Adolescent Health. 2009.

Key points from the paper:
Expedited partner therapy (EPT) is the treating of sex partners without requiring a prior clinical evaluation.

In randomized trials, EPT has reduced the rates of persistent or recurrent gonorrhea and chlamydia infection; however, its routine use is limited by concerns related to liability, cost, compliance, and missed opportunities for prevention counseling.

The Society for Adolescent Medicine (SAM) recommends that providers who care for adolescents should do the following: use EPT as an option for STI care among chlamydia- or gonorrhea-infected heterosexual males and females who are unlikely or unable to otherwise receive treatment; through SAM and AAP chapters, collaborate with policy makers to remove EPT legal barriers and facilitate reimbursement; and collaborate with health departments for implementation assistance.

Providers can become familiar with legal issues concerning implementation of EPT in their state. Information is available at the following:
(1)   The Centers for Disease Control and Prevention (CDC) National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Web site
(2)   The Centers for Law and the Public's Health EPT Web site
(3)   The AAP Division of State Government Affairs at e-mail stgov@aap.org or by telephone at (847) 434-7799
(4)   The American Medical Association (AMA) Web site

The majority (approximately 80%) of the 52 U.S. states and territories studied by CDC and the Centers either expressly permit EPT (15 jurisdictions) or may potentially allow its practice. However, in a number of jurisdictions where EPT is potentially allowed, its legality may be questioned because (1) specific laws to authorize, endorse, or support EPT are absent; or (2) existing laws are contradictory or insufficient to suggest that EPT is specifically allowed.

EPT is potentially allowable in Washington DC, Maryland and Virginia per the current CDC website. (Meaning this issue is subject to additional actions or policies such as supporting policies consistent with legal authorization, or incorporation by reference into treatment guidelines).