POSITION PAPER EXPEDITED PARTNER THERAPY FOR SEXUALLY TRANSMITTED DISEASES

• The Wisconsin Medical Examining Board (MEB) recognizes that the adequate treatment of sexually transmitted diseases (STDs), such as gonorrhea and chlamydia infections, is an important public health issue.

• The MEB recognizes that physicians and other health-care providers play a critical role in preventing and treating STDs.

• The MEB recognizes that adequate treatment and prevention of these infectious diseases often depends on the treatment of the partner(s) of a patient who may not be available or agreeable to direct examination by the physician.

• The MEB further recognizes that it has been common practice for physicians to provide antibiotics for the partner(s) of a patient with an STD without prior clinical examination of the partner, and while this practice is not ideal in terms of diagnosis and prescriptive practice, it is often the only realistic way to reduce the incidence of reoccurrence and transmission of the diseases.

• The United States Centers for Disease Control and Prevention (CDC) has recommended an emerging alternative to traditional partner management for STDs which involves the delivery and prescription of medications to STD patients for their partners without the clinical assessment of the partners. The CDC issued treatment guidelines in 2006 for this form of practice which is known as the “Expedited Partner Therapy” (EPT).

• The American Medical Association has endorsed the practice of EPT as applied to chlamydia and gonorrhea infections. (June 2006)

• The Wisconsin Division of Health and Family Services has also adopted regulations for Sexually Transmitted Diseases Treatment which reference and incorporate the CDC treatment guidelines for EPT. HFS § 145.22, Wis. Admn. Code

• The practice of EPT in accordance with the CDC guidelines may constitute the standard of care with respect to the treatment of STDs of patients with absent partners to reduce the incidence of reoccurrence and transmission of the diseases.

• Given that the public risk of untreated STDs is greater than the risk of complications from dispensing in this less than ideal setting, the MEB recognizes the CDC guidelines for the practice of EPT and supports the passage of legislative authority to expressly authorize the provision of EPT treatment by licensed physicians in Wisconsin.

• Accordingly, until such legislative authority is secured, the MEB recommends that physicians use all reasonable measures available to ensure that appropriate treatment is made available to the patient’s partners. These measures may include offers for low-cost or no-cost examination by the physician of the patient or the referrals to other providers in the community that may offer such services. If an examination of the patient’s partner(s) is not feasible, the physician could choose to follow the CDC guidelines as well as other applicable prescription labeling.

For example, the prescription label should include the patient’s own name and the partner(s) name or, if unknown, the patient’s name followed by the word “partner.” The physician should also assign a separate and unique identifying number to each prescription and clearly identify this number on each corresponding prescription label. The physician should follow appropriate health care record-keeping and provide advice and direction to the patient’s partner(s) for use of the medications, including adverse reactions, complications and the need for follow-up care.

These recommendations may serve as a course of clinical guidance; however each physician or health care provider should always consider the individual clinical circumstances of each person in the context of local disease prevention.