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Improving Women’s Health and Combatting Sexually Transmitted Infections Through Expedited Partner Therapy


Improving Women’s Health and Combatting Sexually Transmitted Infections Through Expedited Partner Therapy

After three years of increases in the incidence rates for sexually transmitted diseases (STI) such as Chlamydia trachomatis, and Neisseria gonorrhoeae over the previous three years, 2017 saw record highs. The Centers for Disease Control and Prevention (CDC) reported that there were more than 1.7 million cases of C. trachomatis, and more than 555,000 cases for N. 2017 gonorrhea - resulting in an increase of 6.8% & 18.5% respectively since 2016.

C. Trachomatis infections are most common in young women (15-24 years old) who account for 45% of all cases reported in 2017.1 reproductive-aged females (age 15-44) made up 65% and 42% respectively of the total C. Trachomatis and N. N. trachomatis and N. gonorrhea cases in 2017.1 Undiagnosed, persistent, or recurring STIs in women can lead to serious reproductive health problems such as ectopic pregnancy and tubal factor infertility. Early data suggests that between 40-70% of male partners remain untreated with STIs. Possible complications of untreated STIs include urethritis and scarring of the reproductive system, epididymitis, and infertility. Disseminated Gonococcal Infection may occasionally occur.

The CDC provides support to clinicians who treat sexual partners of people with C. trachomatis and N. N. trachomatis Although expedited partner therapy may be allowed in 43 states of the union, and 'potentially permissible' in five (SD, KS, and AL), and Puerto Rico, it's currently banned in South Carolina, Kentucky, and Oklahoma. According to state and local guidelines, expedited partner therapy can also be used for trichomoniasis. The evidence for expedited partner therapy in trichomoniasis is mixed. One randomized clinical trial (RCT), which showed that partner therapy reduced repeat infections in infected women, was conclusive. Two other RCTs did not show any effect or were borderline.

The purpose of expedited partner therapy is to be used as an alternative when the partner is unable, or unlikely, to seek treatment promptly. Some of the reasons partners may not engage in care include 1) lack of health insurance; 2) privacy/confidentiality concerns; 3) access to clinical care; and 4) cost or availability of prescription medications. An economic analysis has shown that expedited therapy for STI partners is a cost-saving, cost-effective strategy to manage recurrent or persistent STIs among adolescents.

Due to limited financial resources and the increasing burden of STIs clinicians and public health field investigators might not be able to notify partners of potential C. trachomatis or N. gonorrhoeae exposure. Many clinicians resort to the standard partner referral method for treating sexual partners. This involves the patient notifying their partner about the newly diagnosed STI, and the need to have the clinician evaluate and treat the patient. It is not a good way to ensure partner therapy as it only treats 36% of heterosexual male partners. The notification of partners in sexual relationships is improved with expedited partner therapy. It also increases the trust of the index partner to know that their partner(s) has received treatment. The index patient does not have to disclose the names of their partners and can obtain the required number of expedited therapy prescriptions or medications. Although the benefits of expedited therapy have been proven, there has been a low rate of clinician use. Rosenfeld et al. found that only 11% of healthcare providers used expedited therapy regularly.

One of two delivery methods for expedited partner therapy are available: 1) delivery by the index person of prescriptions to the sex partner(s); or 2) delivery by the index physician of medication to the sex partner(s). Prescriptions can be sent electronically or by fax to a preferred pharmacist. Each state that allows expedited partner treatment has its guidelines for how to send prescriptions. In some states, such as Michigan, "Expedited Partners Therapy" should always be written on a name line, while "January 1 of the current year", may be written on the date of birth line. The index patient and pharmacists should deliver educational materials and resources about STI screening, treatment and potential drug-related adverse reactions at the time of medication pick up. The pharmacist can coordinate the delivery of expedited therapy to the partner and have the ability to check the partner's allergies as well as provide education on reproductive health.

Women of reproductive age (15-44 years) must be assessed regularly for their sexual health. Reproductive health professionals should obtain a proper sexual history (e.g. the Five P's: Partners and Practices, Prevention, Protection from STIs, history of STIs and Practices). These questions will guide sexual health education. To prevent stigmatization, clinicians must be open to their perspectives and judgments regarding STIs and patients' sexual behavior during these visits. Individuals may be unable to disclose their sexual practices and behaviors due to STI-related stigma from their clinicians or their community. This could prevent them from receiving the care they need. Improved clinician-patient relationships will reduce STI-related stigma as well as the perceptions that hinder quality care.

Clinicians should notify the patient and discuss treatment. They can also arrange for retesting if they receive a positive STI test. They might also be able to assist with notifying the patient's partner(s). Web-based platforms can also be used to assist with anonymous notification of sexual partners. In treating STIs, it is important to work with local public health departments and community STI prevention groups. This may reduce the burden of STIs by allowing communities to collaborate and provide education and resources that are not available to all reproductive physicians. If allowed by state legislation and health system policies, the provision of barrier methods, such as male condoms or female condoms, in the office may help to prevent persistent or recurrent STIs. Collaboration with local pharmacies is crucial to ensure that expedited partner therapy is accepted in the community. Partnerships with pharmacists can help ensure that sexual partners' allergies are confirmed, expedited partner therapy prescriptions filled, and education materials are distributed.

Women who provide healthcare for their reproductive health are an integral part of preventing STIs and protecting their health. Protecting them against STI-related morbidity can be done by providing appropriate screening and treatment using all available options.

A clinician-patient relationship will be healthy if a woman can talk with her about her sexual health. This will allow for better education and screening opportunities. As an STI treatment strategy, offering expedited partner therapy to women may decrease the risk of recurrent or persistent STIs as well as STI-related morbidity. Clinicians need to be aware of the laws regarding expedited therapy for women.

Sources:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7136014/

https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/06/expedited-partner-therapy



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