We Have Questions: Sex Partner Treatment for STDs in California

In the state of California, if a person enters a clinic and receives a diagnosis of a sexually transmitted disease (STD) such as gonorrhea, there's a course of action they can take to benefit their partner who passed on the infection.

It's called expedited partner therapy (EPT), which enables treatment of a sex partner without that partner having to come in for evaluation in a clinic or by a healthcare provider elsewhere. Evaluation by a provider if you are already informed there's a good chance you have a sexually transmitted infection (STI) or STD might be best, and "provider-assisted referral" remains "the optimal strategy for partner treatment," according to the Centers for Disease Control and Prevention (CDC).

"EPT is a useful option to facilitate partner management, particularly for treatment of male partners of women with chlamydial infection or gonorrhea," the CDC states.

One form of EPT is patient-delivered partner therapy (PDPT), in which a diagnosed individual can bring the prescribed treatment for the STI/STD to a sex partner. It's a practice adopted in California with a program called Family PACT, which is administered through Medi-Cal. It's provided by select clinics, and accessible through cash-pay prescriptions and obtainable through the EPT Distribution Program run by Essential Access Health.

James Watt, M.D., assistant deputy director of the Center for Infectious Diseases at the California Department of Public Health (CDPH), talked to Giddy about expedited partner therapy and patient-delivered partner therapy. Watt's responses help clarify what the programs entail and their benefits, the use of EPT/PDPT in California, as well as what someone who opts to use EPT/PDPT can expect.

Editor's note: This interview has been edited for length and clarity.

Why does EPT for STDs and STIs work?

Watt: Expedited partner therapy is the clinical practice of treating sex partners of patients diagnosed with treatable sexually transmitted infections and diseases—including chlamydia, gonorrhea and trichomoniasis—without the healthcare provider first examining the partner[s]. Expedited partner therapy typically involves patient-delivered partner therapy [PDPT], in which the patient delivers the medication or a prescription to their partner[s].

[STDs] like chlamydia and gonorrhea are major public health problems; untreated infections are associated with serious adverse health outcomes, including pelvic inflammatory disease, ectopic pregnancy, tubal infertility, perinatal infections and chronic pain, as well as an increased likelihood of acquiring HIV and other STIs.

Reinfection rates are high, in part, because of untreated sex partners. Patients receiving EPT are less likely to get reinfected compared to patients whose partners only receive a referral to treatment.

While it is preferable for partners to come to [a] clinic for in-person sexual healthcare after exposure to treatable STIs, this is not always feasible or realistic. Expedited partner therapy works because it is a way to treat partners who are otherwise unable or unwilling to seek in-person care, thereby preventing reinfections among sex partners.

How has EPT been implemented in California?

California law—California Health and Safety Code [HSC] 120582—allows EPT to be administered but CDPH does not have data on the extent of EPT implementation in California at this time. Senate Bill 306 [Chapter 486, Statutes of 2021] further strengthens California law allowing EPT by naming the practice, referencing U.S. Centers for Disease Control and Prevention guidelines and providing additional guidelines and liability protections for prescribers and pharmacists.

CDPH STD Control Branch recently released a fact sheet that explains these key provisions and implementation of EPT.

What are the benefits of this treatment?

Expedited partner therapy is an effective and important strategy to reduce STI reinfection, ensure treatment of partners and prevent ongoing transmission of STIs. It is safe and acceptable to both patients and partners. Since 2001, no EPT-related adverse events have been reported to the California Department of Public Health.

Expedited partner therapy is cost-effective, and research has shown that EPT prevents reinfection and lowers both healthcare costs and productivity losses.

Are there barriers to implementing EPT in other states, despite CDC recommendations?

According to the CDC, EPT is permissible in 46 states and potentially allowable in four others.

Research on the barriers to EPT implementation in other states has found multiple challenges, including provider concerns about liability and adverse events, funding, health system-level challenges prescribing and documenting EPT in electronic medical records, and a lack of awareness about EPT among healthcare providers and pharmacists.

Liability protections vary by state, and even in states where it is included in the law, providers may not be aware of these protections.

What happens when someone comes in requesting treatment for an STI their partner contracted?

Expedited partner therapy generally works like this: A patient comes to a clinic and is diagnosed with an [STD], such as chlamydia or gonorrhea. The patient reports they have one or more sex partners. If the patient does not believe their sex partner[s] will come to a clinic to access care on their own, EPT should be provided as a best practice to treat the partner[s].

Ideally, EPT medications can be given to the original patient to take directly to their partners. If this is not possible, the prescriber can write a prescription for the partner[s]. If the name of the partner[s] is/are unknown, the prescription can be written in the name of the index patient, with the words "for expedited partner therapy" included.

In a different scenario, a partner could come to a clinic saying they have been exposed to an STI. In this scenario, since the partner is being seen in person, they can undergo full STI screening and can also be prescribed empiric treatment—treatment based on exposure without confirmation of a positive result—cure the infection to which they report having been exposed.

Is EPT in California limited to people with chlamydia or gonorrhea?

Previously, EPT could be used for chlamydia, gonorrhea and any other [STD or] STI as determined by CDPH. [With the passing of] SB 306, which became effective Jan. 1, 2022, EPT use is now allowed for any [STD or] STI as recommended in the most recent CDC guidelines for the prevention or treatment of STDs.

Current CDC guidelines recommend that EPT can be used in the practice of treating the sex partners of persons with diagnosed chlamydia or gonorrhea who are unable or unlikely to seek timely treatment. According to the CDC, existing data also indicate that EPT might have a role in partner management for trichomoniasis.

If someone has a partner who contracted an STI and they want EPT, how should they prepare?

In general, if a person knows they have been exposed to an STI, they should seek in-person healthcare to undergo an exam, full STI screening and any appropriate treatment.

Expedited partner therapy should only be used in cases where a partner is unable or unwilling to seek in-person care. In these cases, an index patient will bring EPT medications or a prescription to their partner, who can then take the medications even without being seen by a provider. Persons who have allergies or other contraindications to EPT medications should not take them. Pregnant people should also be encouraged to seek in-person care rather than taking EPT medications at home.