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Valuable Resources

Evidence Supporting EPT

As a means to assure that exposed partners are adequately treated, health departments and
providers in many areas are practicing expedited partner therapy (EPT) by which partners of
STI patients are treated without an examination and without counseling messages. Among
EPT practices, some providers are utilizing patient-delivered partner therapy (PDPT) in which
patients diagnosed with STI deliver medications to their partners. To encourage more widespread
consideration of these partner management options, the CDC published its 2006 guidance
report, Expedited Partner Management in the Treatment of Sexually Transmitted Diseases.

The guidance summarized evidence based on the results of four randomized controlled trials
(RCT) for the efficacy of EPT in preventing recurrent chlamydia and gonorrhea infections after
initial treatment and in assuring that partners are notified and receive treatment. Additionally,
the RCT demonstrated that EPT was associated with a decreased likelihood that a patient
would have sex with an untreated partner. The following salient findings related to EPT are
found within the CDC guidance:

• In one six-city multi-center study, female patients diagnosed with chlamydia that were provided azithromycin to give to their partners were statistically no more likely to have persistent or recurrent chlamydia infections at one-month and four-month follow-up than were women who were provided a list of clinics where their partners could be examined.
• In Seattle-King County, persistent or recurrent gonorrhea and chlamydia infections were
  found less often among male and female patients assigned to deliver medications to their
  partners than among patients assigned to patient referral or provider referral arms of the
  study. EPT was shown to be more effective at preventing recurrent gonorrhea infections
  than chlamydia infections.
• In New Orleans, among a subset of 977 men with symptomatic urethritis who were diagnosed with gonorrhea, chlamydia, or both, those assigned to the PDPT arm of the study were significantly less likely to experience a recurrent infection upon follow-up testing.
• PDPT was slightly more costly than patient referral when considering only program costs.
  However, when the costs from preventing infection sequelae such as PID are considered,
  EPT was shown to be more cost effective.

The CDC has been joined by the American Medical Association in recommending that EPT be considered and implemented as a partner management strategy. (Region VIII Infertility Prevention Project - EPT Toolkit)
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Centers for Disease Control and Prevention. Expedited Partner Therapy in the Management of Sexually Transmitted Diseases. Atlanta, GA: US Department of Health and Human Services, 2006.