Chlamydia and gonorrhea remain the two most common bacterial STD infections statewide. In 2005, California reported more than 130,000 chlamydia cases and more than 34,000 gonorrhea cases. Los Angeles County alone reported more than 38,000 cases of chlamydia and 10,000 cases of gonorrhea.

Genital chlamydia and gonorrhea infections can lead to pelvic inflammatory disease, ectopic pregnancy, chronic pelvic pain and infertility. Complications are more likely with repeat infections, and both diseases increase the risk of sexually acquired HIV.

Eleven percent to 13 percent of men and women are reinfected with gonorrhea or chlamydia within six months after treatment. To prevent repeat infections and reduce further transmission in the community, sexual partners of infected patients must be provided timely and appropriate antibiotic treatment.

Provider Responsibilities for Ensuring Partner Treatment
Patients diagnosed with chlamydia or gonorrhea infection cannot be considered adequately treated until all their sexual contacts within the past 60 days have been treated. California law still requires physicians to elicit the sexual partners of infected patients and attempt to evaluate and treat them.

The standard of care for partner management for chlamydia and gonorrhea has been either provider referral or patient referral. Because providers often lack the resources necessary to directly notify at-risk partners of infected patients and because patient referrals may not be effective, a new partner management strategy called expedited partner therapy was developed.

Expedited partner therapy is defined as treatment of sex partners without intervening clinical assessment. This strategy bypasses obligatory clinical evaluation and professional counseling and is an effective alternative to provider or patient referral.

There are several possible approaches to expedited partner therapy. The most common is to have the patient deliver the medication to his or her sex partners. Other options include allowing partners to pick up medication or prescriptions from providers' offices or pharmacies.

Provider use of expedited partner therapy has been legal for chlamydia since 2001 and for gonorrhea since Jan. 2007. These laws provide an important means to combat a serious public health problem and prevent adverse reproductive health outcomes. However, expedited partner therapy is not intended as a first-line treatment, but as an effective alternative when the partner is unable or unlikely to seek prompt care.

Studies show that expedited partner therapy is at least as effective as--and perhaps better than--patient referral in preventing reinfection in heterosexual men and women with chlamydia or gonorrhea.

Data on the efficacy of this strategy in men who have sex with men are currently lacking. There is also a high risk of STD co-morbidity in this population. Studies suggest that the rate of undiagnosed HIV in male-to-male contact involving chlamydia and gonorrhea is around 6 percent. For these reasons, expedited partner therapy for men who have sex with men should be used only when other strategies are unsuccessful.

Provider guidelines for patient-delivered chlamydia and gonorrhea therapy are:

Patient Diagnosis--Make clinical diagnosis of genital chlamydia or gonorrhea infection.

First-Choice Strategy--Attempt to bring partners in for complete clinical evaluation, STD testing, counseling and treatment.

Drug Regimens for Partners--Prescribe the following for partners of:
* Patients diagnosed with chlamydia, but not gonorrhea:
Azithromycin (Zithromax) 1 gram (250 mg tablets x 4) orally once
* Patients diagnosed with gonorrhea with or without chlamydia:
Cefpodoxime (Vantin) 400 mg orally once PLUS Azithromycin (Zithromax) 1 gram (250 mg tablets x 4) orally once

Number of Doses--Limited to the number of known sex partners in the past 60 days.

Educational Materials--Provide materials with medication and include clear instructions, warnings and referrals.

Counseling--Advise abstinence until seven days after treatment and until seven days after partners have been treated.

Retesting--Recommend retesting three months after treatment.

Adverse Reactions--Report adverse reactions via e-mail to EPT@dhs.ca.gov or call 510/620-3400. The law does not protect providers from liability.

For more information about the Los Angeles County STD Program's patient-delivered partner therapy guidelines, visit www.lapublichealth.org/std/providers.htm.

For more information on expedited partner therapy, visit the Centers for Disease Control and Prevention Web site at www.cdc.gov/std/ept/default.htm.

Sarah Guerry, MD, is the medical director of the STD Program in the Los Angeles County Department of Public Health. Tracie McClain, MD, MPH, is the director of special projects for the STD Program.