A public health program in the US State of Washington promoting the use of expedited partner therapy (EPT)--the treatment, without medical evaluation, of sex partners of patients diagnosed with a curable STI--increased EPT use and may have reduced rates of STI in the population, though the intervention's effectiveness in reducing STIs in the general population requires further confirmation, according to a study published this week in PLOS Medicine. Matthew Golden, from the University of Washington in Seattle, USA, and colleagues randomly assigned 23 of 25 local health jurisdictions in Washington to one of four study groups, rolled out the program sequentially at 6-8 month intervals, and compared outcomes between groups and within groups before and after the intervention.
Although clinical trials of EPT have shown that the approach increases partner treatment and decreases gonorrhea and chlamydial reinfection rates, EPT has not been widely adopted in the US. The researchers designed this study primarily to test whether promotion of EPT (through educating physicians, supplying them with free partner treatment packs, and by making free packs available through commercial pharmacies for doctors to prescribe for their patients' partners) could reduce STI transmission.
The results show that EPT use almost doubled following institution of the study intervention. There was also a reduction for the two STIs they measured, chlamydia and gonorrhea. However, over the entire 22-month study period there was a substantial overall reduction of both diseases in Washington (also seen, to a lesser degree, in rates of gonorrhea in neighboring states). This background drop, together with other changing circumstances that were unrelated to the trial but might have influenced the results, made it harder for the researchers to detect statistically significant changes in STI resulting from the study intervention. The researchers estimate that the program was responsible for an approximately 10% reduction in both diseases, but this result was not statistically significant.
Encouraged by the increases in EPT use they observed, the researchers suggest that the public health intervention used in this trial provides a model for health departments seeking to increase EPT. They also conclude that continued use, expansion, and examination of EPT as a way to reduce STI transmission are warranted.
Funding: MRG, RPK, JPH, and KKH received funding from National Institute of Allergy and Infectious Diseases (R01AI068107, http://www.
Competing Interests: Pfizer pharmaceuticals provided free azithromycin used in the study. MRG has received research support from Melinta pharmaceuticals and Cempra pharmaceuticals for his participation as an investigator in trials of new drug treatments for gonorrhea. MRG has received a consulting fee from Melinta pharmaceuticals.
Citation: Golden MR, Kerani RP, Stenger M, Hughes JP, Aubin M, et al. (2015) 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 12(1): e1001777. doi:10.1371/journal.pmed.1001777
Author Affiliations: University of Washington, United States Public Health--Seattle & King County, United States Washington State Department of Health, United States
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