Expedited Partner Therapy (EPT) Guidelines
Defining expedited partner therapy
Expedited partner therapy (EPT) refers to treating the sex partners of persons with a curable sexually transmitted infection (STI) without requiring that the partner first undergo a medical evaluation. In most instances, this involves giving a patient medication to give to their sex partners, or patient delivered partner therapy (PDPT).
Questions about EPT
Yes. There have been three published randomized controlled trials of EPT conducted in the U.S., including one conducted in King County, WA1,2,3. These studies demonstrated that EPT decreases the risk of reinfection among heterosexuals with gonorrhea or chlamydial infection, and increases the proportion of partners who receive treatment. This conclusion is further supported by a meta-analysis of randomized trials and observational studies and by a review conducted by the U.S. Centers for Disease Control and Prevention.4,5
1 Schillinger JA, Kissinger P, Calvet H, et al. Patient-delivered partner treatment with azithromycin to prevent repeated Chlamydia trachomatis infection among women: a randomized, controlled trial. Sex Transm Dis. Jan 2003;30(1):49-56.
2 Golden MR, Whittington WL, Handsfield HH, et al. Effect of expedited treatment of sex partners on recurrent or persistent gonorrhea or chlamydial infection. N Engl J Med. Feb 17 2005;352(7):676-685.
3 Kissinger P, Mohammed H, Richardson-Alston G, et al. Patient-delivered partner treatment for male urethritis: a randomized, controlled trial. Clin Infect Dis. Sep 1 2005;41(5):623-629.
4 Trelle S, Shang A, Nartey L, Cassell JA, Low N. Improved effectiveness of partner notification for patients with sexually transmitted infections: systematic review. Bmj. Feb 17 2007;334(7589):354.
5 CDC. Expedited partner therapy in the management of sexually transmitted diseases. Atlanta: U.S. Department of Health and Human Services;2006.
Yes. EPT is legal in Washington state. Washington state has had an EPT program since the late 1990s and tens of thousands of persons have received EPT since that time. Prior to the start of the program, the issue of EPT legality was reviewed by the Washington tate Department of Health, The Washington State Board of Medical Quality Assurance and the Washington State Pharmacy Board, all of which supported the use of EPT. Medical providers giving patients medication to give to their sex partners are required to ensure that partners receive written information about the medications, including an allergy warning. This information is included in the free EPT packs provided by Public Health and these packs have been approved by the Washington State Board of Pharmacy.
EPT is safe. No instances of major adverse reactions were reported in randomized trials of EPT, nor have such reactions been observed through public health surveillance undertaken with the widespread roll out of EPT in Washington State. A large study assessing the risk of missed STI diagnoses in persons receiving medical evaluations because of contact to sex partners with gonorrhea or chlamydia found that the risk of concurrent STI diagnoses (including HIV infection) was very low among heterosexuals6. HIV was relatively common among MSM seeking care as because of an exposure to gonorrhea or chlamydia and, in part, it is because of this risk that EPT is not recommended in MSM. Public Health in King County attempts to contact all MSM with gonorrhea or chlamydia with the goal of assisting them with partner notification and treatment.
6 Stekler J, Bachmann L, Brotman RM, et al. Concurrent sexually transmitted infections (STIs) in sex partners of patients with selected STIs: implications for patient-delivered partner therapy. Clin Infect Dis. Mar 15 2005;40(6):787-793.
Yes. When possible, partners of persons with gonorrhea should be treated with ceftriaxone 250mg IM and azithromycin 1g orally once. However, at present, cefixime resistance among persons with gonorrhea in King County is very uncommon (<1%), and providers should use oral therapies (cefixime 400mg plus azithromycin 1g) if ceftriaxone is not available or if intramuscular therapy is not feasible. EPT is an extremely effective intervention in heterosexuals with gonorrhea; it reduces the risk of reinfection by 60-70%. At present, the balance of risks and benefits favors giving EPT to heterosexual patients with gonorrhea.
Yes. Medical providers in Washington State use more EPT than in any other part of the U.S. Based on interviews with randomly selected patients, over half of heterosexuals with gonorrhea or chlamydia are offered them medication to give to their partner(s) by their medical provider, and one-third report receiving medication to give to their partner(s)7.
7 Golden MR, Kerani RP, Stenger M, et al. Uptake and Population-Level Impact of Expedited Partner Therapy (EPT) on Chlamydia trachomatis and Neisseria gonorrhoeae: The Washington State Community-Level Randomized Trial of EPT. PLoS Med. Jan 2015;12(1):e1001777.
Guidelines for use
Providers should offer heterosexual patients medication to give to their sex partners if the provider cannot otherwise assure the partners' treatment. This guideline is consistent with current guidelines from the U.S. Centers for Disease Control and Prevention and Washington State Guidelines, and has been endorsed by the Washington State Board of Medical Quality Assurance.
Instructions on how to prescribe EPT through community pharmacies
Federal guidance no longer permits purchases of these medications for widespread distribution.
Providers can call or fax the EPT prescription form directly to one of the King County or statewide pharmacies listed in the links below. Only these pharmacies stock the free PDPT packs. Providers who wish to fax prescriptions to a pharmacy should use a King County EPT prescription form (link below). When prescribing these packs, please indicate to the pharmacy that you wish to call-in the free EPT medication Pack 1 (Chlamydia) or Pack 2 (Gonorrhea). Use EPT prescription form for each sex partner.
- 2016 Guidelines for the Use of Expedited Partner Therapy in Men who Have Sex with Men
- Washington State Sexually Transmitted Disease EPT
- WA State Medical Quality Assurance Commission Policy Statement
- WA State Medical Association Resolution on EPT
- American Medical Association Statement on EPT
- CDC review and guidance on EPT
If you have any questions or concerns related to EPT, please contact Cheryl Malinski at 206-744-2262.
Link/share our site at www.kingcounty.gov/ept