Increasing Rates of Partner Treatment as a Population-level Tool for STD Control

BACKGROUND: Expedited partner therapy (EPT) for sex partners of people infected with gonorrhea and chlamydial infection is recommended as a clinical option in states other than where state laws appear to prohibit the practice. More recently, the Centers for Disease Control has attended to EPT as a broad programmatic option to facilitate partner treatment and thereby population-level sexually transmitted disease (STD) control. Using a framework of population-level prevention impact, this talk describes the rationale for expanding the use of EPT nationally, contingencies for programmatic use, and current efforts to expand EPT use. METHODS: Putative legal prohibitions were most frequently cited as barriers to EPT uptake. An assessment of the legal landscape pertinent to EPT in 2005 – 2006 established a baseline for measuring coverage interventions. CDC's 2008 recommendations for integrated partner services (HIV, syphilis, gonorrhea, chlamydial infection) presented a framework for programs, and CDC collaborated with states and professional organizations interested in facilitating EPT. RESULTS: By 2009, there was a doubling in the number of states expressly permitting EPT and a 30% decline in the number with specific prohibitions. States that created protocols and legal permissions and professional organizations that explicitly endorsed EPT as an option contributed to the expansion of EPT. DISCUSSION: In terms of prevention impact, an efficacious and widely applicable intervention addressing a population that contributes to morbidity has achieved greater coverage in that population. This background sets the stage for the greater incorporation of patients and partners into the population-level goal through expedited partner services.