What is the standard of care for Expedited Partner Therapy (EPT) in Sexually Transmitted Infections (STIs) without a medical history of the partner needing expedited therapy?

From the Guidelines

Expedited Partner Therapy (EPT) is recommended for partners of patients diagnosed with chlamydia or gonorrhea when the partner is unlikely to seek timely medical care, and the standard of care includes prescribing azithromycin 1 gram orally as a single dose for chlamydia, and cefixime 800 mg orally as a single dose for gonorrhea (often combined with azithromycin) 1. The goal of EPT is to reduce reinfection rates by treating partners who might otherwise remain untreated, breaking the cycle of transmission while acknowledging that many partners face barriers to seeking traditional medical care. When implementing EPT, it is essential to provide clear written instructions about medication use, potential side effects, and warnings about allergies. Partners should be advised to avoid sexual activity for 7 days after treatment and to seek medical care if they experience severe adverse reactions or have symptoms that persist after treatment. It's crucial to note that EPT is not recommended for men who have sex with men due to the higher risk of coinfection with HIV and syphilis, or for pregnant women who should receive full evaluation 1. EPT is legally permitted in most U.S. states, but providers should verify local regulations. Key considerations for EPT include:

• Evaluating all sex partners of infected patients from the preceding 60 days for infection
• Treating partners with appropriate antibiotics, such as azithromycin and cefixime
• Providing clear instructions and warnings about medication use and potential side effects
• Advising partners to avoid sexual activity for 7 days after treatment and to seek medical care if necessary
• Retesting patients diagnosed with chlamydial or gonococcal infection 3 months after treatment to prevent reinfection 1.

From the Research

Expedited Partner Treatment (EPT) for STIs

• EPT is a method of partner treatment used by medical providers to treat patients' sexual partners without direct medical evaluation or counseling 2.
• The effectiveness of EPT has been studied, and it has been found to result in improved or equivalent rates of reinfection in adolescents and adults with Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis 2.

Standard of Care for EPT

• The standard of care for EPT in STIs without having a medical history of the partner needing expedited therapy is not explicitly stated in the provided studies.
• However, the 2021 CDC guidelines on sexually transmitted infections recommend a higher dose of ceftriaxone for gonorrhea and doxycycline as first-line therapy for chlamydia 3.
• The management of Neisseria gonorrhoeae in the United States involves the use of ceftriaxone and doxycycline, with the 2021 CDC STI Treatment Guidelines recommending 500mg ceftriaxone intramuscularly once for the treatment of uncomplicated gonorrhea at all anatomic sites 4.

Diagnosis and Treatment of STIs

• The diagnosis and treatment of STIs, including gonorrhea, chlamydia, syphilis, Mycoplasma genitalium, trichomoniasis, and genital herpes, have been reviewed, with nucleic acid amplification tests having high sensitivities and specificities for the diagnosis of gonorrhea, chlamydia, M genitalium, trichomoniasis, and symptomatic HSV-1 and HSV-2 5.
• Effective STI prevention interventions include screening, contact tracing of sexual partners, and promoting effective barrier contraception 5.

Historical Context

• Historical guidelines for the treatment of sexually transmitted diseases, such as those released by the Centers for Disease Control and Prevention in 1998, have been updated to reflect advances in treatment, including effective single-dose regimens for many sexually transmitted diseases and improved therapies for herpes infections 6.