Download Expedited Partner Therapy

Policy and Procedure
TITLE: Expedited Partner Therapy for Chlamydia and Gonorrhea
Chapter: Provision of Care
Effective Date: 9/2015
Date Last Reviewed: 7/2015
Developed/Reviewed by: Director of Nursing
Revision: NEW
POLICY –It is the policy of One World Community Health Center to provide a mechanism for
patient-delivered partner therapy to the sex partners of persons with sexually transmitted diseases
without an intervening medical evaluation or clinical assessment in order to reduce the risk of reinfection among persons treated for STDs, prevent disease complications, and reduce
transmission to un-infected persons.
PURPOSE –This policy was created to establish standards for expedited drug therapy for
partners whom have the sexually transmitted diseases Chlamydia and Gonorrhea among One
World patients.
REFERENCES –
1. Centers for Disease Control and Prevention. Expedited partner therapy in the management of
sexually transmitted diseases. Atlanta, GA: US Department of Health and Human Services,
2006. Society for Adolescent Medicine position statement supported by the American
Academy of Pediatrics March 4, 2009
2. State of Nebraska Statute 71-503.02
PROCEDURES –
AUTHORITY
Nebraska Statute 71-503.02. Chlamydia or gonorrhea; prescription oral antibiotic drugs;
powers of medical professionals; restrictions.
The physician, a physician assistant, a nurse practitioner, or a certified nurse midwife
licensed under the Uniform Credentialing Act who has diagnosed a patient as having Chlamydia
or gonorrhea, may prescribe or provide drug samples of prescription oral antibiotic drugs to that
patient's sexual partner or partners without examination of that patient's partner or partners.
Adequate directions for use and medication guides, where applicable, shall be provided along
with additional prescription oral antibiotic drugs for any additional partner. The physician,
physician assistant, nurse practitioner, or certified nurse midwife shall at the same time provide
written information about Chlamydia and gonorrhea to the patient for the patient to provide to
the partner or partners. The oral antibiotic drugs prescribed, provided, or dispensed pursuant to
this section must be stored, dispensed, and labeled in accordance with federal and state pharmacy
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Policy and Procedure
laws and regulations. Prescriptions for the patient's sexual partner or partners must include the
partner's name.
EXPEDITED PARTNER THERAPY ELIGIBILITY
1. The ideal approach for the partner(s) of a patient diagnosed with any STD is to be
evaluated, examined, tested, counseled, and treated by a medical provider.
2. If there is cause to reasonably believe that a patient’s partner(s) will be unwilling or
unable to seek treatment within the context of a traditional patient-provider relationship,
Expedited Partner Therapy (EPT) may be used.
3. The patient must have a documented positive test result for Gonorrhea and/or Chlamydia.
4. Gonorrhea and Chlamydia infection in women: EPT can be used to treat partners as an
option when the patient’s partner is unwilling or unable to seek treatment. Symptomatic male
partners should be encouraged to seek medical attention, in addition to accepting therapy by
Expedited Partner Therapy (EPT).
5. Gonorrhea and Chlamydia infection in men: EPT can be used to treat partners as an
option the patient’s partner is unwilling or unable to seek treatment. Female recipients of
EPT should be strongly encouraged to seek medical attention, in addition to accepting
therapy. It is particularly important that female recipients of EPT who have symptoms that
suggest acute PID, such as abdominal or pelvic pain, seek medical attention.
6. Gonorrhea and Chlamydia infection in men who have sex with men: EPT should not be
considered a routine partner management strategy because data are lacking on the efficacy in
this population, and because of a high risk of co-morbidity, especially undiagnosed HIV
infection. EPT should only be used selectively, and with caution, when other partner
management strategies are impractical or unsuccessful.
7. The partner has no contraindication to treatment with Azithromycin.
8. One-dose therapy is being prescribed.
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NOTE: EPT is not appropriate for use in cases of child abuse, sexual assault, sexual abuse, or in
cases where the patient's safety is in doubt.
Recommended Partner Treatment
Gonorrhea:
Azithromycin 1gm in a single dose
PLUS
Cefixime 400 mg orally in a single dose
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Policy and Procedure
Chlamydia:
Azithromycin 1gm orally in a single dose
PROCEDURE
1. Confirm that there is a positive test result for Gonorrhea and/or Chlamydia in the
patient’s chart
2. Determine the need for EPT by engaging in open discussions with patients to ascertain
their partners' abilities to access medical services.
3. If there is cause to reasonably believe that a patient’s partner(s) will be unwilling or
unable to seek treatment within the context of a traditional patient-provider relationship
should the EPT may be used.
4. Medication or prescriptions may be provided for all partners who have been sexually
exposed within the two months prior to the onset of symptoms or diagnosis and who are
unlikely to submit to a medical exam.
5. If a patient reports having no partners within the last two months, EPT may be provided
for the most recent partner.
6. The preferred method of EPT is to give the medication directly to the patient to deliver to
their partner(s).
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Patient delivered medications must be properly labeled;
o The name and address of the clinic
o Current Date
o Partner Name
o Provider Name
o Directions for use
o The drug name and strength and quantity
7. A written prescription must include the partner’s name
8. A separate prescription must be provided for each partner.
9. If locating information is available, OneWorld nursing staff will attempt to contact the
partner to see if they have followed up with their medical provider or offer an
appointment at OneWorld for follow up if they do not have a primary care provider.
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Policy and Procedure
10. EPT activities will be documented in a log kept on the PHI drive to include;
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Date of encounter
Index patient name and DOB
Partner name and DOB (if known)
Partner phone number and address (if known)
Medication prescribed
Lot number and expiration date of medication prescribed
11. The partner must receive written information as outlined below
Partner Information
Written partner informational materials are printed in the partner’s language and given to the
patient to deliver to each partner. A referral for partner evaluation is included. Key partner
counseling messages include:
 Partners should seek a complete STD evaluation as soon as possible.
 Partners should read the informational material very carefully before taking the
medication
 Partners who have allergies to antibiotics or who have serious health problems
should not take the medication and should see a health care provider.
 Partners who have symptoms of a more serious infection (e.g., pelvic pain in
women, testicular pain in men, or fever in men or women) should not take Patient
Delivered Partner Therapy and should seek care as soon as possible.
 Partners who are or who could be pregnant should seek care as soon as possible.
 Patients and partners should abstain from sex for at least seven days after
treatment and for seven days after all partners have been treated, in order to
reduce the risk of recurrent infection.
 Partners should re-test three months after treatment.
STANDING ORDERS
Nursing staff may provide EPT per this policy and at the direction of the medical provider.
Hyperlinks
Chlamydia Partner Treatment Information Sheet
Gonorrhea Treatment Information Sheet.docx
EPT LOG
APPROVED BY:
Policy Review Committee
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Policy and Procedure
________________________________________________
SIGNATURE
Kristine McVea, MD, MPH
CMO, OneWorld CHC
SIGNATURE
Board Secretary
_________________
DATE
DATE
Related Policies:
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