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Defining expedited partner therapy

Expedited partner therapy (EPT) refers to treating the sex partners of persons with a curable sexually transmitted infection (STI) without requiring that the partner first undergo a medical evaluation. In most instances, this involves giving a patient medication to give to their sex partners, or patient delivered partner therapy (PDPT).

Questions about EPT

Yes. There have been three published randomized controlled trials of EPT conducted in the U.S., including one conducted in King County, WA1,2,3. These studies demonstrated that EPT decreases the risk of reinfection among heterosexuals with gonorrhea or chlamydial infection, and increases the proportion of partners who receive treatment. This conclusion is further supported by a meta-analysis of randomized trials and observational studies and by a review conducted by the U.S. Centers for Disease Control and Prevention.4,5

1 Schillinger JA, Kissinger P, Calvet H, et al. Patient-delivered partner treatment with azithromycin to prevent repeated Chlamydia trachomatis infection among women: a randomized, controlled trial. Sex Transm Dis. Jan 2003;30(1):49-56.

2 Golden MR, Whittington WL, Handsfield HH, et al. Effect of expedited treatment of sex partners on recurrent or persistent gonorrhea or chlamydial infection. N Engl J Med. Feb 17 2005;352(7):676-685.

3 Kissinger P, Mohammed H, Richardson-Alston G, et al. Patient-delivered partner treatment for male urethritis: a randomized, controlled trial. Clin Infect Dis. Sep 1 2005;41(5):623-629.

4 Trelle S, Shang A, Nartey L, Cassell JA, Low N. Improved effectiveness of partner notification for patients with sexually transmitted infections: systematic review. Bmj. Feb 17 2007;334(7589):354.

5 CDC. Expedited partner therapy in the management of sexually transmitted diseases. Atlanta: U.S. Department of Health and Human Services;2006.

Yes. EPT is legal in Washington state. Washington state has had an EPT program since the late 1990s and tens of thousands of persons have received EPT since that time. Prior to the start of the program, the issue of EPT legality was reviewed by the Washington tate Department of Health, The Washington State Board of Medical Quality Assurance and the Washington State Pharmacy Board, all of which supported the use of EPT. Medical providers giving patients medication to give to their sex partners are required to ensure that partners receive written information about the medications, including an allergy warning. This information is included in the free EPT packs provided by Public Health and these packs have been approved by the Washington State Board of Pharmacy.

EPT is safe. No instances of major adverse reactions were reported in randomized trials of EPT, nor have such reactions been observed through public health surveillance undertaken with the widespread roll out of EPT in Washington State. A large study assessing the risk of missed STI diagnoses in persons receiving medical evaluations because of contact to sex partners with gonorrhea or chlamydia found that the risk of concurrent STI diagnoses (including HIV infection) was very low among heterosexuals6. HIV was relatively common among MSM seeking care as because of an exposure to gonorrhea or chlamydia and, in part, it is because of this risk that EPT is not recommended in MSM. Public Health in King County attempts to contact all MSM with gonorrhea or chlamydia with the goal of assisting them with partner notification and treatment.

6 Stekler J, Bachmann L, Brotman RM, et al. Concurrent sexually transmitted infections (STIs) in sex partners of patients with selected STIs: implications for patient-delivered partner therapy. Clin Infect Dis. Mar 15 2005;40(6):787-793.

Yes. When possible, partners of persons with gonorrhea should be treated with ceftriaxone 250mg IM and azithromycin 1g orally once. However, at present, cefixime resistance among persons with gonorrhea in King County is very uncommon (<1%), and providers should use oral therapies (cefixime 400mg plus azithromycin 1g) if ceftriaxone is not available or if intramuscular therapy is not feasible. EPT is an extremely effective intervention in heterosexuals with gonorrhea; it reduces the risk of reinfection by 60-70%. At present, the balance of risks and benefits favors giving EPT to heterosexual patients with gonorrhea.

Yes. Medical providers in Washington State use more EPT than in any other part of the U.S. Based on interviews with randomly selected patients, over half of heterosexuals with gonorrhea or chlamydia are offered them medication to give to their partner(s) by their medical provider, and one-third report receiving medication to give to their partner(s)7.

7 Golden MR, Kerani RP, Stenger M, et al. 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. Jan 2015;12(1):e1001777.

Guidelines for use

Providers should offer heterosexual patients medication to give to their sex partners if the provider cannot otherwise assure the partners' treatment. This guideline is consistent with current guidelines from the U.S. Centers for Disease Control and Prevention and Washington State Guidelines, and has been endorsed by the Washington State Board of Medical Quality Assurance.

Public Health - Seattle & King County (Public Health) provides free medications to providers for their heterosexual patients to give to their sex partner(s). Medical providers can obtain free PDPT packs to treat their patients' sex partners either by prescribing PDPT packs through community pharmacies participating in Public Health's EPT program, or by stocking PDPT packs in their clinic or office. These packs meet the requirements of the WA State Board of Pharmacy and include medication, medication instructions and allergy warnings in English and Spanish, condoms and information about STDs.

Instructions on how to prescribe EPT through community pharmacies

Providers can call or fax the EPT prescription form directly to one of the King County or statewide pharmacies listed in the links below. Only these pharmacies stock the free PDPT packs. Providers who wish to fax prescriptions to a pharmacy should use a King County EPT prescription form (link below). When prescribing these packs, please indicate to the pharmacy that you wish to call-in the free EPT medication Pack 1 (Chlamydia) or Pack 2 (Gonorrhea). Use EPT prescription form for each sex partner.

King County pharmacies providing free Public Health medications for sex partner treatment
See also: Statewide pharmacies providing free EPT medication for sex partners

Bartell Drug stores

3902 "A" Street SE
Phone: 253-939-8563
Fax: 253-939-0869

Bellevue North
10116 NE 8th St
Phone: 425-454-2468
Fax: 425-454-3734

22833 Bothell Everett Hwy
Phone: 425-481-7810
Fax: 425-485-9179

Bridle Trails (Kirkland)
6619 132nd Ave NE
Phone: 425-881-5544
Fax: 425-869-2227

Broadway (Seattle)
1407 Broadway
Phone: 206-726-3491
Fax: 206-726-3798

14901 4th Ave SW
Phone: 206-242-1202
Fax: 206-431-5157

Downtown Seattle (3rd & Union)
1404 3rd Ave
Phone: 206-624-1401
Fax: 206-624-3508

Queen Anne (Seattle)
601 1st Ave N
Phone: 206-284-1354
Fax: 206-378-6060

Redondo (Des Moines)
27055 Pacific Hwy S
Phone: 253-839-1693
Fax: 253-839-2876

University Village (Seattle)
2700 University Village Pl NE
Phone: 206-525-0705
Fax: 206-525-0740

White Center
9600 15th Ave SW
Phone: 206-763-2728
Fax: 206-762-7630

Rite-Aid Drug stores

1509 Auburn Way S
Phone: 253-939-1939
Fax: 253-931-1150

Federal Way
32015 Pacific Hwy S
Phone: 253-945-6011
Fax: 253-946-0258

Kent (Panther Lake)
20518 108th Ave SE
Phone: 253-854-2999
Fax: 253-850-7631

North Seattle
13201 Aurora Ave N
Phone: 206-364-7676
Fax: 206-367-2596

601 S Grady Way, Suite P
Phone: 425-226-3461
Fax: 425-277-0696

Seward Park (Seattle)
9000 Rainier Ave S
Phone: 206-760-1076
Fax: 206-760-2655

South Seattle
2707 Rainier Ave S
Phone: 206-721-5018
Fax: 206-722-6047

Fred Meyer stores

801 Auburn Way N
Phone: 253-931-5584
Fax: 253-931-5578

Federal Way
33702 - 21st Ave SW
Phone: 253-952-0133
Fax: 253-952-0142

10201 SE 240th St
Phone: 253-859-5533
Fax: 253-859-5541

How to obtain free EPT medication packs to stock at your office or clinic

Providers can request to have EPT medications sent to them to stock in their office or clinic by using the faxable request form.

Washington State DOH Background and Recommendations for incorporating patient delivered partner therapy (PDPT) by health care providers

Other resources

If you have any questions or concerns related to EPT, please contact Cheryl Malinski at 206-744-2262.

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