Use of expedited partner therapy limited by feelings of discomfort, liability

Issue: May 2014

Although expedited partner therapy has proven to be beneficial in reduction of STI rates, few providers utilize the service because of discomfort related to treatment of a first-time patient, liability, and other barriers, according to data presented at the 2014 Society for Adolescent Health and Medicine Annual Meeting.

Perspective from Lawren Wellisch, MD

The CDC defines expedited partner therapy as the clinical practice of treating the sexual partner of those diagnosed with chlamydia or gonorrhea without the health care provider examining the partner.

Cynthia J. Mears, DO, of the Advocate Children’s Hospital, Oak Lawn, Ill., and colleagues conducted a three-phase study to determine the usage of STI screening and expedited partner therapy (EPT) and identify barriers to screening or treatment. During phase 1, researchers distributed surveys to 44 pediatric health care providers and 59 adolescents aged 12 to 24 years to determine EPT use, STI screening, and hindrance to care. In phase 2, researchers formed focus groups with providers to further define barriers identified in the surveys. Phase 3 consisted of a community asset map and a STI/EPT toolkit researchers created based on providers’ needs.

While 81.8% of providers reported they offer STI screenings and diagnosis, 10.8% of adolescents said they had been tested for STIs; 25% of providers reported use of EPT in their practice. The primary barriers of EPT use reported by providers included: discomfort treating a patient they had never seen before (77.1%); treating an STI without screening for others (55.4%); and liability (45.7%). Despite these barriers, 86.8% of providers said they were willing to participate in an EPT training program.

“While pediatric providers are offering STI screening and diagnosis, adolescents are not being screened per CDC recommendations. EPT has proven to be an asset in reducing STI rates and long-term complications. To increase health care provider comfort levels, our group has distributed a toolkit containing informational booklets. In conjunction with STI/EPT toolkit, our team has assembled an asset map for the described catchment area,” the researchers concluded.

For more information:

Mears CJ. Abstract 120. Presented at: SAHM 2014; March 23-26, 2014; Austin, Texas.

Perspective

Lawren Wellisch, MD

Chlamydia and gonorrhea present major public health burdens for our adolescent community. Increasing the utilization of expedited partner therapy is critical to reducing the rates of these infections, as many teens may continue to spread disease while they remain asymptomatic. However, the psychosocial complexities of adolescent sexual relationships must present numerous logistical and emotional barriers to the use of expedited partner therapy. Interventions that target increasing physician knowledge and offering of expedited partner therapy are promising and may positively impact teens' access to rapid treatment of STIs.

Lawren Wellisch, MD

Department of Pediatrics, University of Chicago, Comer Children's Hospital

Disclosures: Wellisch reports no relevant financial disclosures.