Nearly 2.3 million times last year, Americans learned they had a sexually transmitted disease (STD).

But despite these record-high infection rates for chlamydia and gonorrhea, most patients only receive treatment for their own infection—when they probably could get antibiotics or a prescription for their partner at the same time.

The Centers for Disease Control and Prevention has recommended this approach—called “expedited partner therapy (EPT)”—since 2006, as a way to slow the growing STD epidemic. Most states have laws allowing doctors who diagnose a patient with an STD to write a prescription or provide medications for their partner, sight unseen. The laws also allow clinics and pharmacies to distribute STD treatment for partners.

In a new paper in the American Journal of Public Health, three University of Michigan physicians describe the barriers that stand in the way of getting EPT to more people.

Overcoming those barriers, they say, could prevent many STD infections, including reinfections of people who have already gotten tested and treated.

Cornelius Jamison, MD, MSPH, MSc, led the team behind the paper, and also leads current research that is diving deeper into the barriers that may prevent the clinical implementation and use of EPT. He notes that this is one public health issue where public policy is ahead of clinical practice. Many major medical societies have endorsed EPT based on evidence that it’s cost-effective and safe, but it’s still underused across the country.

“We need to make sure everyone in the medical and public health community has a basic understanding of what EPT is, how it can work, and what it will take for it to reach widespread use,” says Jamison, a family physician and member of the U-M Department of Family Medicine and Institute for Healthcare Policy and Innovation. The new paper includes a conceptual framework that diagrams all the potential barriers to EPT use, to help guide future work to overcome them.

Special considerations for STDs

Some of the barriers to widespread use of EPT relate to the very nature of the diseases it’s designed to treat, and the stigma attached to an STD infection. This can drive teens and young adults to avoid seeking STD testing and care in ways that would tip their parents off to their infection status through insurance records, bills, or notifications of a positive test result.

Instead, Jamison says, they may seek a diagnosis or treatment at a walk-in clinic, on a free or cash basis. This means that such sites are especially important to increasing the use of EPT.

Similarly, these patients’ partners may not have insurance, or may not want to use their insurance to pay for an STD test or treatment even if they do.

A packet of EPT antibiotics given to them by a partner who got tested and treated could overcome these barriers, says Jamison. So could a pre-written prescription.

—Newswise