When a patient leaves her doctor’s office she does not normally head home with additional prescriptions for patients her clinician never met. An innovative approach to treating sexually transmitted diseases (STDs), however, allows patients to snag certain medications for an unlimited number of recent sexual partners. The strategy aims to keep the spread of such diseases in check.
Under this system the patient visit would typically proceed as usual with one twist: After the patient is diagnosed by a medical professional and given a prescription to fill at the pharmacy, the clinician would also write prescriptions for each sexual partner the infected patient may have been involved with in the past 60 days or so. Depending on the state, the patient can give the clinician those partners’ names or simply get prescriptions written anonymously. Often the patient can then fill all those prescriptions at the pharmacy and give the medications—with typical drug inserts outlining proper use and side effects—to those contacts.
The practice has quietly caught on in most states. Along the way, it has netted support from both sides of the political aisle and major public health groups such as the U.S. Centers for Disease Control and Prevention and the American Medical Association. The approach, called expedited partner therapy (EPT), tries to address the reality that sexual partners—particularly those who are male or asymptomatic—often do not go get treatment for sexual infections even when their infected partners urge them to do so. New CDC treatment guidelines for STDs released on June 4 point out that although the success of this approach differs by the sex of the first patient and by STD, three clinical trials of heterosexual men and women with chlamydia or gonorrhea all found that more partners were treated using this strategy than the traditional method of patients telling their sexual partners to contact a doctor.
Expedited partner therapy has spread from state to state since California first authorized it in 2001 as an avant-garde way to help reduce rates of chlamydial infection. The state later expanded its policy to include treatment for gonorrhea and other STDs and many other states have followed their lead. In recent years the number of states that officially prohibit the strategy has dwindled to four—and if new legislation passes in Ohio, that number may soon drop to three.
Curbing the spread of sexual infections like chlamydia or gonorrhea hinges on sexual partners taking a short course of treatment—typically a seven-day cycle of antibiotics or even a single dose. But study after study has shown that sex partners, especially if they are asymptomatic, often do not visit a doctor for needed drug treatments. As a result, couples can get into a vicious cycle of reinfection or an untreated partner can go on to infect others. Passing along drugs to one’s sexual partners, however, can help reduce the spread of these infections.
The proposed new bill in Ohio, which would permit a clinician to treat two partners of one patient without having to examine them, comes when the state’s rate of gonorrhea, according to the latest CDC statistics, is higher than 43 other states. For every 100,000 Ohioans, 144 have been afflicted with gonorrhea and 460 with chlamydia. The state’s bill allows sexual partners to remain anonymous. But if the patient does tell his or her provider the name of sexual partners, then the clinician is obligated to try to contact them under the proposed law to share information about the STD as well as the drug, its uses and potential side effects. The bill has bipartisan support and sponsorship and is backed by the Ohio State Medical Association. It already passed the state’s House by a vote of 89–6 and is also expected to pass the Senate later this year. If the bill does not pass, however, medical providers must continue to rely on the traditional approach of asking their patients to tell their partners to go get examined and treated.
Still unclear, however, is whether the solution for one problem (preventing STDs) will trigger a whole different set of problems—namely, drug resistance. Already, drug-resistant gonorrhea was specifically highlighted in the CDC’s national report on antibiotic resistance as an “urgent threat.” And if someone starts medication for one of these STDs and then does not finish it—something that may be more likely if that person does not understand why he needs to take the full course or does not realize he must complete it even if he feels fine—then that could potentially contribute to the growth of antibiotic resistance. Although clinicians in states with expedited partner therapy do still encourage sexual partners to come in for counseling and examination, the partners may not do so. Yet exactly how much such policies could contribute to drug resistance, however, remains unknown because the question has not been studied.
For its part, the CDC says it is unlikely that expedited partner therapy has been a substantial contributor to drug resistance in the past. “Historically, antibiotic use in the United States has not played a major role in development of resistant gonorrhea—instead, data suggest that resistant strains have been imported from other countries,” physician Robert Kirkcaldy, a medical epidemiologist at the CDC’s Division of STD Prevention, wrote via e-mail. Still, he added, “Although importation from other countries is probably the main way that resistant gonorrhea appears in the United States, it is conceivable that antibiotic use plays a role in propagation of resistant strains.” The agency is not currently specifically researching whether EPT contributes to resistance.
The bacteria responsible for sexually transmitted gonorrhea first appeared to develop resistance to one of the two antibiotics recommended by the CDC in the 1990s but epidemiological data suggest that the resistant strains were at least initially imported from Southeast Asia, according to the centers. The strains emerged initially in Hawaii and California, two states with close travel linkages to Southeast Asia, before spreading eastward across the U.S. “CDC is currently investigating the potential role of antibiotic use in the United States on gonorrhea resistance, and additional research on whether EPT contributes to resistance might be helpful,” Kirkcaldy says. But so far, it appears that medical professionals can combat STDs and antibiotic resistance at the same time.