Expedited Partner Therapy for Gonorrhea and Chlamydia Decreases Visits for Reinfection Among STD Clinic Patients

Background:Expedited partner therapy (EPT), or direct delivery of antibiotics to partners by the index patient, is associated with reduced gonorrhea (GC) and chlamydia (CT) reinfection in clinical trials when compared to the partner management standard of patient referral.

Objectives:To evaluate the impact of EPT in STD clinics in Baltimore, Maryland, by comparing clinic reinfection rates between patients receiving EPT and historical (pre-EPT) controls.

Methods: Heterosexual patients diagnosed with GC or CT were offered EPT as standard practice starting in October of 2007. We used the clinic-based electronic medical record system to identify reinfection events in a 90-day follow up period after treatment. We compared reinfection rates in the EPT group to those of heterosexual patients testing positive for CT or GC in the same time period the previous year. We used Pearsons’ Chi-square test to compare reinfection rates between the groups.

Results:In an initial analysis, 1,085 patients (525 male, 560 female) received EPT for at least one partner from October 2007 - March 2009, and 2,111 (1,202 male, 909 female) were in the historical cohort (January 2006 – June 2007). There were fewer reinfection events in patients in the EPT group compared to patients in the pre-EPT group. The difference was significant at the p=0.05 level (2.1% for the EPT group vs. 3.4% for the pre-EPT group, p=0.05).

Conclusions: Our preliminary analysis shows a benefit associated with use of EPT as partner management for GC and CT infection compared to standard patient referral.

Implications for Programs, Policy, and/or Research: A preliminary analysis suggests that EPT is effective in reducing reinfection with GC and CT in the Baltimore City STD clinic setting. A future analysis will assess the impact of patient characteristics and STD surveillance trends on the outcomes of EPT.