Download Patient-Delivered Therapy of Antibiotics for Chlamydia trachomatis

Expedited Partner Therapy for
Chlamydia Trachomatis and Neisseria Gonorrhoeae:
Guidance for Health Care Professionals in Illinois
Illinois Department of Public Health (IDPH)
Sexually Transmitted Diseases Section*
INTRODUCTION
As of January 1, 2010, Illinois health care professionals have a new option for ensuring
effective partner treatment for the sex partners of patients diagnosed with Chlamydia
trachomatis and Neisseria gonorrhoeae. On August 24, 2009, Governor Pat Quinn
signed Senate Bill 212 into law (PA 96-613) authorizing the use of expedited partner
therapy (EPT). PA 96-613 amended Sections 3 and 6 of the Illinois Sexually
Transmissible Disease Control Act (410 ILCS 325/3) from Ch. 111 ½, par. 7403) and
(410 ILCS 325/6) (from Ch. 111 ½, par. 7406), added Section 64 to the Medical Practice
Act of 1987 (225 ILCS 60/64 new), amended the Nurse Practice Act by adding Section
70-170 (225 ILCS 65/70 – 170 new), and amended the Physician Assistant Practice Act
of 1987 by adding Section 25 (225 ILCS 05/25 new). EPT is the general term for the
practice of treating sexual partners of patients diagnosed with chlamydia and/or
gonorrhea without an intervening medical evaluation. EPT is an alternative strategy for
ensuring that sex partners get needed medication thus reducing the likelihood of reinfection and potential further dissemination of these diseases within the community.
PA 96-613 allows health care professionals, including licensed physicians, physician
assistants, and advanced practice nurses to dispense antibiotic therapy for the sex
partners of individuals infected with Chlamydia trachomatis and Neisseria gonorrhoeae,
even if they have not been able to perform an exam of the patient’s sex partner(s).
The following guidelines concerning EPT provide information on the most appropriate
patients, medications, and counseling procedures recommended to maximize patient
and public health benefit while minimizing risk.
*The guidance was developed in collaboration with the Chicago Department of Public Health
and in consultation with the Minnesota Department of Health and California Department of
Public Health Sexually Transmitted Diseases Control Branch who allowed Illinois Department of
Public Health to use their EPT guidances.
Illinois EPT Guidance
Revised: January 7, 2010
Page 1
Summary Guidance for Expedited Partner Therapy (EPT)
EPT Eligible Patients: Persons with a clinical diagnosis of Chlamydia
trachomatis or Neisseria gonorrhoeae, preferably confirmed with a laboratory
test
EPT Eligible Partners: Sex partners of patients treated for chlamydia and/or
gonorrhea who were exposed within the previous 60 days (or most recent sex
partner if none in the previous 60 days), and who are unable or unlikely to
seek medical care. (See page 6 for additional recommendations)
First-choice Partner Management Strategy: Attempt to refer partners in for
complete clinical evaluation, STD/HIV testing, counseling, and treatment
Recommended Drug Regimens for Sex Partners Receiving EPT:
o Patients diagnosed with chlamydia, but not gonorrhea:
 Azithromycin (Zithromax*) 1 gram (500 mg tablets x 2) orally
once
o Patients diagnosed with gonorrhea but not chlamydia:
 Cefixime (Suprax*) 400 mg orally once
o Patients diagnosed with both gonorrhea and chlamydia:
 Cefixime (Suprax*) 400 mg orally once, PLUS
 Azithromycin (Zithromax*) 1 gram (500 mg tablets x 2) orally
once
Informational Materials: Health care professionals must provide patients
participating in EPT with counseling and written materials (developed by the
Illinois Department of Public Health) for their sex partners, including:
o A warning about administering EPT to pregnant partners;
o Information about the antibiotic and dosage provided or prescribed;
o Information about the treatment and prevention of STDs;
o Requirement of abstinence until a period of time after treatment;
o Notification of the importance of sex partners to receive testing for HIV
and other STDs;
o Notification of the risk to self, others, and the public health if the STD is
not completely treated;
o The responsibility of the sex partner to inform his/her sex partners of
the risk of STDs and importance of examination and treatment; and
o Other information deemed necessary by the Department.
Patient Re-testing: Patients treated for chlamydia and/or gonorrhea should
be re-tested three months after treatment to identify possible re-infection.
Liability: Illinois EPT legislation protects health care professionals providing
EPT from civil and professional liability, except for willful and wanton
misconduct. The same protection applies to health care professionals
choosing not to provide EPTand to pharmacists or pharmacies that do not fill
an EPT prescription which violates any provision of the Illinois Pharmacy
Practice Act.
* Use of trade names is for identification only and does not imply endorsement.
Illinois EPT Guidance
Revised: January 7, 2010
Page 2
BACKGROUND AND RATIONALE
Public Health Importance of Chlamydia and Gonorrhea
Sexually transmitted chlamydia and gonorrhea infections are significant public health
problems. More than 59,000 cases of chlamydia and 20,000 cases of gonorrhea were
reported in Illinois in 2008 [1], making them the top two most common reportable
communicable infections. Genital infections can lead to pelvic inflammatory disease
(PID), chronic pelvic pain, ectopic pregnancy, and preventable infertility in women [2].
Patients with these infections are also at increased risk of acquiring sexually transmitted
HIV [3]. Repeat gonorrhea infections, which increase the risk of complications, occur in
up to 11 percent of women and men within six months after treatment [4, 5]. Repeat
chlamydia infections occur in up to 13 percent of patients in this same time period [6].
To prevent repeat infections, reduce complications in individuals, and reduce further
transmission of infection in the community, sex partners of infected patients must be
provided timely and appropriate antibiotic treatment.
Barriers to Effective Partner Management
Currently, there are considerable challenges to effective partner management. Public
health efforts to notify and treat sex partners have proven successful and are
considered a cornerstone of syphilis control [7]. However, because of the high burden
of infection and limited public health resources for partner notification activities, it is
difficult for local health departments to provide investigation and partner notification for
cases of gonorrhea and chlamydia [8]. Thus, the standard of care for partner
management for gonorrhea and chlamydia cases has become patient referral, whereby
health care providers counsel patients about the need for partner treatment and that the
responsibility for notifying partners rests with the patient.
The effectiveness of patient referral is limited by the patient’s choice in notifying the
partner, as well as the partner’s choice in seeking treatment. Asymptomatic partners
often fail to seek care because they have no signs or symptoms of infection, and they
incorrectly assume they are not infected. Additionally, some partners may be
uninsured and have limited access to medical care. These limitations to the
effectiveness of partner referral demonstrate the need for additional strategies to ensure
sex partner treatment such as expedited partner therapy.
Expedited Partner Therapy
Expedited partner therapy (EPT) for sexually transmitted disease is an alternative
strategy for ensuring that sex partners get needed medication. EPT is the general term
for the practice of treating sex partners of patients diagnosed with an STD without an
intervening medical evaluation. Patients deliver either the medication or prescriptions
for medication to their sex partner(s).
Illinois EPT Guidance
Revised: January 7, 2010
Page 3
Evidence for the Effectiveness of EPT for Chlamydia and Gonorrhea
Several research studies, including randomized clinical trials, have demonstrated that
EPT is effective in facilitating partner notification and reducing recurrent chlamydia and
gonorrhea infection among index cases. A recent meta-analysis that included five
clinical trials showed an overall reduced risk (summary risk ratio 0.73, 95 percent
confidence interval (CI) 0.57 to 0.93) of recurrent infection in patients with chlamydia or
gonorrhea who received EPT, compared with those who received standard partner
treatment methods [9].
One randomized trial demonstrated that partner management strategies that included
EPT as an option, compared with conventional strategies, significantly reduced
recurrent gonorrhea or chlamydial infection among heterosexual men and women [10].
In this study, EPT was more effective than standard referral in reducing recurrent
infection among patients with gonorrhea (3 percent versus 11 percent, p = 0.01),
compared with those with chlamydial infection (11 percent versus 13 percent, p = 0.17).
In a separate study, of men with urethritis, EPT, compared with patient referral, reduced
recurrent infection rates by half, from 43 percent to 23 percent [11]. In another study, of
women with chlamydia, EPT reduced recurrent infection rates from
15 percent to 12 percent (p = .10) [12].
A report published by the U.S. Centers for Disease Control and Prevention (CDC) in
2006 provided a thorough review of the research literature, a discussion of
programmatic issues related to EPT, and guidance for public health programs and
clinicians [13].
Implementation and Use of EPT
In a national physician survey conducted in 2000, researchers at CDC found that the
practice of EPT for chlamydia and gonorrhea was not uncommon [14, 15]. Currently, 20
states including Illinois have legalized EPT.
In 2006, the Centers for Disease Control and Prevention (CDC) issued Expedited
Partner Therapy in the Management of Sexually Transmitted Diseases; Review and
Guidance. This document recommends the use of EPT as an option to facilitate partner
management in heterosexual men and women infected with chlamydia and/or
gonorrhea. This document is available at the CDC Website, www.cdc.gov/std/ept.
Considerations in Using EPT
There are several concerns about EPT. First, the medication could cause a serious
adverse reaction, including allergy. However, adverse reactions to recommended EPT
medications, beyond mild side effects, are rare. Second, EPT may compromise the
quality of care provided to sex partners, particularly if it is used as a first-line approach
for partners who would otherwise seek clinical services. Appropriate care for sex
Illinois EPT Guidance
Revised: January 7, 2010
Page 4
partners to persons with chlamydia and gonorrhea infections includes testing for other
STDs and HIV, physical examination to rule out a complicated infection, and riskreduction counseling. Ideally, partners who receive EPT will still access these clinical
services. Despite these concerns, the benefits of EPT outweigh the risks, since doing
nothing for these partners is more harmful. Further, these risks may be mitigated
through patient education and written materials for partners that provide warnings and
encourage visiting a health care provider.
Additional concerns about EPT include misuse of the medication, waste if the
medication is not delivered or not taken, and contribution to antibiotic resistance at the
population level. Currently, there is no evidence that EPT is misused or leads to
increasing antimicrobial resistance.
EPT in Illinois
In the spring, Senate Bill 212 was introduced, subsequently passed overwhelmingly in
both legislative houses and was signed into law by Governor Quinn on August 24, 2009
with an effective date of January 1, 2010. A copy of this legislation is available at
www.idph.state.il.us/health/std/096_0613.pdf. The Illinois law allows health care
professionals (physicians, physician assistants, and advanced practice nurses) to
dispense antibiotic therapy for the male and female sex partners of individuals infected
with Chlamydia trachomatis or Neisseria gonorrhoeae, even if they have not been able
to perform an exam of the patient’s partner(s). This new law provides an important
means to combat a serious public health problem and prevent adverse reproductive
health outcomes.
This option allowing health care professionals to use EPT is not intended as the first
and optimal choice of treatment for partners of individuals diagnosed with gonorrhea
and chlamydia. However, this strategy can serve as a useful alternative when the
partner is unable or unlikely to seek care. Providers should use their best judgment to
determine whether partners will or will not come in for an examination and treatment,
and to decide whether or not to dispense or prescribe additional medication for the
index patient to give to his/her sexual partner(s).
Liability Issues
Illinois EPT legislation protects health care professionals (HCPs) providing prescription
antibiotics to sex partners (EPT) without fee or compensation from civil and professional
liability, except in cases of willful and wanton misconduct. HCPs must provide the index
patient with counseling and written materials (developed by the Illinois Department of
Public Health) for his/her sex partner(s). The same protection applies to health care
professionals choosing not to provide EPT and to pharmacists or pharmacies that do
not fill an EPT prescription which violates any provision of the Illinois Pharmacy Practice
Act.
Illinois EPT Guidance
Revised: January 7, 2010
Page 5
GUIDELINES FOR USING EPT FOR CHLAMYDIA AND GONORRHEA IN ILLINOIS
Selecting Appropriate Patients for EPT
Appropriate patients are those with a clinical diagnosis of sexually transmitted
chlamydia or gonorrhea infection, preferably with laboratory confirmation. Laboratory
confirmation of the diagnosis may include a gram stain of male urethral exudate
showing gram negative intracellular diplococci indicative of gonorrhea; a positive culture
test for chlamydia or gonorrhea; or a positive nucleic acid amplification test (NAAT) for
chlamydia or gonorrhea (e.g., GenProbe Aptima, Becton Dickinson ProbeTec, Roche
polymerase chain reaction (PCR) Amplicor). Because of their high sensitivity, NAATs
are the tests of choice for chlamydia and gonorrhea screening and testing.
Providing EPT without laboratory confirmation should only be considered when the
provider has a high clinical suspicion for chlamydia or gonorrhea infection in the index
case and there is concern about loss of follow-up.
Clinicians should attempt to motivate patients to refer their partners for comprehensive
health care, including evaluation, testing and treatment. Clinical services provide the
opportunity to ensure treatment; confirm the diagnosis; examine the patient; test for
other STDs, HIV and pregnancy; provide needed vaccinations; and offer risk-reduction
counseling and community referrals. These services constitute the standard of care for
all partners of patients infected with a sexually transmitted infection.
Thus, patients most appropriate for EPT are those with partners who are unable or
unlikely to seek prompt clinical services. Factors to consider in the patient’s report are
that the partner is uninsured, lacks a primary care provider, faces significant barriers to
accessing clinical services, or will be unwilling to seek care. Providers also should
assess the acceptability of EPT to both the patient and the partners receiving it. Even if
EPT is provided, the partner should still be encouraged to seek follow-up care as soon
as possible.
Providers should assess the partner’s symptom status, particularly symptoms indicative
of a complicated infection; pregnancy status; and risk for severe medication allergies. If
the partner is pregnant, every effort should be made to contact her for referral to
pregnancy services and/or prenatal care. The local health department may be of
assistance in notifying and referring pregnant partners for these special situations. For
partners with known severe allergies to antibiotics, EPT should not be used.
Illinois law permits EPT regardless of the patient’s gender or sexual orientation.
However, the use of EPT to treat certain partners [e.g., females, and men who have sex
with men (MSM)] may increase the risk of under-treating a complicated infection or
missing a concurrent STD/HIV infection in the partner. Further, EPT is not appropriate
for patients co-infected with STDs not covered by EPT medication; cases of suspected
child abuse or sexual assault; or a situation in which the patient’s safety is in doubt.
Illinois EPT Guidance
Revised: January 7, 2010
Page 6
Sex Partner Treatment
Illinois law does not mandate a specific antibiotic. Recommended antibiotic regimens
for EPT are listed in the table below.
Infection Diagnosed in Index
Patient
Chlamydia only
Gonorrhea only (NAAT for
chlamydia negative)
Gonorrhea and chlamydia
(Includes situations in which the
chlamydia and/or gonorrhea test
results are not yet available in a
patient with clinical signs of
gonorrhea/chlamydia.)
Recommended Medication for EPT




Azithromycin (Zithromax*) tablets 1 gram
(500 mg tablets x 2) orally once
Cefixime (Suprax) 400 mg orally once
Cefixime (Suprax) 400 mg orally once,
PLUS
Azithromycin (Zithromax*) tablets 1 gram
(500 mg tablets x 2) orally once
*Use of trade names is for identification only and does not imply endorsement.
On April 13, 2007, CDC released data showing an increasing and high prevalence of
fluoroquinolone-resistant Neisseria gonorrhoeae in the United States, and
recommended that fluoroquinolones (ciprofloxacin, ofloxacin, levofloxacin) no longer be
used to treat gonorrhea. Few oral cephalosporins have been studied and found to be
effective against gonorrhea. Cefixime remains a recommended regimen to treat
uncomplicated infections of the cervix, urethra or rectum. A single dose of 400 mg is an
appropriate medication for EPT for gonorrhea infections [16].
In general, oral cephalosporins are less effective in eradicating pharyngeal gonorrheal
infection. Providers who are concerned that the partner is at risk for pharyngeal
infection, specifically if the partner has been exposed to a male urethral infection at this
site, should discuss with the patient that oral treatment may not cure pharyngeal
gonorrhea in all patients and that the partner should still seek care.
Patients infected with gonorrhea have high rates (35 percent to 50 percent) of
co-infection with chlamydia [17]. Because of the high sensitivity of NAATs for
chlamydial infection, a patient’s negative chlamydial NAAT result precludes the need for
the patient or partner(s) to be treated for chlamydia. However, if chlamydial test results
are not available or if a non-NAAT was negative for chlamydia, the patient and
partner(s) should be treated for both gonorrhea and chlamydia [18]. For EPT, unless
chlamydia infection is ruled out with the use of a NAAT, azithromycin treatment is
necessary for the presumptive treatment of chlamydia in patients diagnosed with
gonorrhea.
Illinois EPT Guidance
Revised: January 7, 2010
Page 7
Azithromycin two grams orally should not be used for EPT. Although small studies have
shown that this regimen is effective against uncomplicated gonococcal infections, it
causes significant gastrointestinal distress, and may be expensive. In addition, some
concerns that widespread use may lead to the emergence of antimicrobial resistance
have been raised.
Options for Delivery of Antibiotics to Partners
1. Dispense medication directly to the patient for delivery to partner(s).
a) The patient should be given enough doses to treat each sex partner in the
past 60 days whom the patient feels confident contacting, and who are
unable or unlikely to seek medical care. If the patient reports no sex
partners in the past 60 days, provide one dose for the most recent sex
partner if the partner is unable or unlikely to seek medical care.
b) The law does not specify how many partners may be treated through EPT.
c) Medication packets should contain drugs described above in
“Recommended Treatment Regimens.”
d) Labeling of medication packets should adhere to Illinois Pharmacy
Practice Act stipulations.
2.
Dispense prescription to the patient to be delivered to partner(s) who is
unable or unlikely to seek medical care. Partner(s) presents the prescription
to a pharmacy of his/her choice to be filled.
a) The patient should be given one prescription for each sex partner in the
past 60 days whom the patient feels confident contacting and who is
unable or unlikely to seek medical care. If the patient reports no sex
partners in the past 60 days, provide one prescription for the most recent
sex partner who is unable or unlikely to seek medical care.
A combination of partner strategies also may be used, for example, a patient with
several partners may refer one partner to a health care professional but take EPT
for other partners.
Risk of Adverse Reactions to Medications
Adverse reactions to single-dose cefixime and azithromycin, beyond mild to moderate
side effects, are rare. As of December 2009, there have been no reports of adverse
events related to EPT in California, since its implementation in 2001. This risk of allergy
and adverse drug reactions may be best mitigated through educational materials that
accompany the medication, which include explicit warnings and instructions for partners
who may be allergic to penicillin, cephalosporins, or macrolides, to seek medical advice
before taking the medication. Examples of partner therapy instructions and information
are available in English and Spanish at www.idph.state.il.us/health/std/ept_cg.htm.
Illinois EPT Guidance
Revised: January 7, 2010
Page 8
All known adverse reactions should be reported to the Illinois Department of Public
Health, STD Section by telephone: 217-782-2747. Known adverse reactions to cefixime
and azithromycin are as follows:
 Cefixime
Cefixime is generally well tolerated. The most common side effects in patients
receiving a single-dose regimen of 400 mg are loss of appetite, nausea, diarrhea
and vomiting.
Approximately 1 percent to 3 percent of patients have a primary hypersensitivity
to cephalosporins; however, rates and cross-reactivity vary, depending on the
molecular structure [18]. The risk of anaphylaxis with cephalosporin in the
general population is 0.0001 percent to 0.1 percent [19-21]. However, patients
with IgE-mediated allergy to penicillin are at increased risk for severe allergic
reactions to cephalosporins. Evidence of IgE-mediated allergy include
anaphylaxis, hypotension, laryngeal edema, wheezing, angioedema, and/or
uticaria.
Approximately 10 percent of patients report penicillin allergy; however, more than
90 percent of them are found not to be allergic and are able to tolerate the drug
[22]. Cephalosporins are less allergenic than penicillin. The risk of
cephalosporin reaction among patients with penicillin allergy is 5 percent to
17 percent for first-generation cephalosporins, 4 percent for second-generation,
and only 1 percent to 3 percent for third- and fourth-generation cephalosporins
[23]. Cefixime, and other cephalosporins recommended for the treatment of
gonorrhea are all third-generation cephalosporins.
In a retrospective cohort study of patients receiving penicillin and a subsequent
cephalosporin, the risk of an allergic event was about 10-fold higher among those
who had had a prior allergic reaction to penicillin; however, the absolute risk of
anaphylaxis was very small: one in 100,000 [24]. Further, because the risk was
similarly elevated among those subsequently given a sulfonamide antibiotic,
cross-reactivity may not be an adequate explanation for the increased risk.
The American Academy of Pediatrics guidelines, which establish a medicolegal
standard of care, state that third-generation cephalosporins can be used to treat
penicillin-allergic patients as long as the penicillin reaction is not severe (i.e., not
IgE-mediated) [19, 20]. Skin testing for penicillin allergy is recommended for
patients if the allergic reaction was consistent with IgE-mediated mechanism or if
the history is unclear [25]. Such partners should be brought in for treatment for
gonorrhea exposure.
Illinois EPT Guidance
Revised: January 7, 2010
Page 9
 Azithromycin
Azithromycin is generally well tolerated [26]. The most common side effects in
patients receiving a single-dose regimen of one gram of azithromycin are related
to the gastrointestinal system: diarrhea/loose stools (7 percent), nausea
(5 percent), abdominal pain (5 percent), vomiting (2 percent), and dyspepsia (1
percent). Vaginitis occurs in about 1 percent of women taking azithromycin. No
other side effects have been documented with a frequency greater than one
percent. Anaphylaxis or severe allergy to macrolides generally, and to
azithromycin specifically, is very rare. Two grams of azithromycin are not
recommended as EPT for gonorrhea.
Risk of Under-treating Complicated Infections and Missing Concurrent STD/HIV
Another risk of EPT is missing concurrent STD and HIV infections. There is particular
concern related to using EPT in men who have sex with men (MSM) because of the risk
of missing an undiagnosed HIV infection. In a multi-site study of STD/HIV co-infection
among STD patients who presented as contacts to infection, 6.3 percent of MSM had
newly diagnosed HIV infection [27]. The risk of missing new HIV infections may be less
in areas with ready access to HIV screening. Thus far, research on the effectiveness of
EPT in reducing repeat infection has been limited to heterosexual populations.
Risks can be mitigated through educational materials that clearly instruct all EPT
recipients that they should seek care for STD and HIV testing, regardless of whether or
not they take the medication. In particular, those with specific symptoms such as pelvic
pain or testicular pain should seek medical care; pregnant women should seek regular
prenatal care and receive a test-of-cure; and MSM should seek HIV testing. Examples
of partner therapy instructions and information are available in English and Spanish
online at www.idph.state.il.us/health/std/ept_cg.htm. Assistance from the local health
department also may be available for these challenging partner situations.
EPT and Pregnancy
Although EPT is not contraindicated when a patient reports that his female partner may
be pregnant, every effort should be made to contact the pregnant partner and ensure
that she is referred for appropriate medical care. EPT for pregnant partners only should
be considered as a last resort. The local health department may be of assistance in
notifying and referring pregnant partners for these special situations. The need for a
test-of-cure for chlamydia and gonorrhea in pregnancy in three weeks should be
emphasized. Both recommended EPT regimens are safe in pregnancy.
Illinois EPT Guidance
Revised: January 7, 2010
Page 10
Required Education and Counseling
According to Illinois EPT law, health care professionals must provide patients infected
with chlamydia and/or gonorrhea counseling and written materials* (developed by the
Illinois Department of Public Health) for their partners who will receive EPT either as a
prescription to be filled or medication to be taken.
Required patient counseling and written materials for EPT partners include:
A warning about administering EPT to pregnant partners;
Information about the antibiotic and dosage provided or prescribed;
Information about the treatment and prevention of STDs;
Requirement of abstinence for seven days after treatment;
Notification of the importance of sex partners to receive testing for HIV and other
STDs;
Notification of the risk to self, others, and the public health if the STD is not
completely treated;
The responsibility of the sex partner to inform his/her sex partners of the risk of
STDs and importance of an examination and treatment; and
Other information deemed necessary by IDPH.
Although not required by EPT law, health care professionals should advise patients that
if their partners have symptoms of a more serious infection (e.g., pelvic pain in women,
testicular pain in men, fever in men or women) the partners should not take the EPT
medications and should seek care as soon as possible.
*See Appendices A – F for partner written materials (Treatment Fact Sheets) in English
and Spanish. The same are available at www.idph.state.il.us/health/std/ept_cg.htm.
Persons Repeatedly Infected With STDs
Health care professionals should counsel, as well as provide, written materials to
patients who have a history of two or more sexually transmitted diseases concerning the
increased risks related to re-infection and subsequent complications such as pelvic
inflammatory disease, ectopic pregnancy, etc., and increased risk of HIV
acquisition/transmission. A fact sheet for patients with repeat infections is provided in
Appendix G and is available at www.idph.state.il.us/health/std/ept_cg.htm.
Patient Follow-up and Re-testing at Three Months
To ensure the effectiveness of EPT, providers should schedule both male and female
patients to return for re-testing for gonorrhea and chlamydia three months after
treatment. It also is recommended that sex partners who receive EPT be re-tested for
chlamydia and gonorrhea three months after treatment.
Illinois EPT Guidance
Revised: January 7, 2010
Page 11
RESOURCES
Illinois EPT Resources:




EPT partner information materials are available at
www.idph.state.il.us/health/std/ept_cg.htm. Materials are available in English
and Spanish, and include instructions for chlamydia treatment, gonorrhea
treatment, and combination treatment (both chlamydia and gonorrhea).
Adverse reaction reporting by telephone at 217-782-2747.
Illinois EPT legislation is available at www.idph.state.il.us/health/std/096_0613.pdf.
For information on local chlamydia and gonorrhea control efforts, please call your
local health department STD control program, visit the Illinois Department of
Public Health Web site at www.idph.state.il.us, or call the Illinois Department of
Public Health STD Section at (217)782-2747.
CDC STD Practice Guidelines


STD Treatment Guidelines 2006. Available online at www.cdc.gov/std/treatment
Expedited Partner Therapy in the Management of Sexually Transmitted
Diseases. 2006. Available online: www.cdc.gov/std/EPT
References Cited:
1. Illinois Department of Public Health STD Section. Chlamydia and Gonorrhea
2008 Tables.
2. Hook, E.W,; Handsfield, H.H. Gonococcal infections in the adult. In: Holmes,
K.K.; Sparling, P.F.; Mardh, P-A, et al., eds. Sexually Transmitted Diseases, 3rd
Edition. New York, NY: McGraw-Hill, 1999:451-466
3. Wasserheit, J.N. Epidemiological synergy. Interrelationships between human
immunodeficiency virus infection and other sexually transmitted diseases. Sex
Transm Dis 1992;19:61-77
4. Mehta, S.D,; Erbelding, E.J.; Zenilman, J.M. and Rompalo, A.M. Gonorrhoea
reinfection in heterosexual STD clinic attendees: longitudinal analysis of risks for
first reinfection. Sex Transm Infect 2003;79:124-8
5. Peterman, T.A.;Tian, L.H.; Metcalf, C.A., et al. High incidence of new sexually
transmitted infections in the year following a sexually transmitted infection: A
case for rescreening. Ann Intern Med 2006;145:564-72
6. Whittington, W.L.; Kent, C.; Kissinger, P., et al. Determinants of persistent and
recurrent Chlamydia trachomatis infection in young women: Results of a
multicenter cohort study. Sex Transm Dis 2001;28:117-123
7. Oxman, A.D.; Scott, E.A.; Sellors, J.W., et al. Partner notification for sexually
transmitted diseases: an overview of the evidence. Can J Public Health 1994;85
Suppl 1:S41-7
8. Golden, M.R.; Hogben, M,; Handsfield, H.H.; St. Lawrence, J.S.; Potterat, J.J.
and Holmes, K.K. Partner notification for HIV and STD in the United States: low
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Revised: January 7, 2010
Page 12
coverage for gonorrhea, chlamydial infection, and HIV. Sex Transm Dis
2003;30:490-496
9. Trelle, S.; Shang, A.; Nartey, L.; Cassell, J.A. and Low, N. Improved
effectiveness of partner notification for patients with sexually transmitted
infections: systematic review. BMJ 2007;334:354-61
10. Golden, M.R.; Whittington, W.L.; Handsfield, H.H., et al. Effect of expedited
treatment of sex partners on recurrent or persistent gonorrhea or chlamydial
infection. N Engl J Med 2005;352:676-85
11. Kissinger, P.; Richardson-Alson, G.; Leichliter, J. and et al. Patient-delivered
partner treatment for male urethritis: a randomized, controlled trial. Clin Infect Dis
2005;41:623-9
12. Schillinger, J.A.; Kissinger, P.; Calvet, H., et al. Patient-delivered partner
treatment with azithromycin to prevent repeated Chlamydia trachomatis infection
among women: a randomized, controlled trial. Sex Transm Dis 2003;30:49-56
13. Centers for Disease Control and Prevention. Expedited partner therapy in the
management of sexually transmitted diseases. Atlanta, GA: U.S. Department of
Health and Human Services, 2006. www.cdc.gov/std/ept
(http://www.cdc.gov/std/treatment/EPTFinalReport2006.pdf). Accessed March
2007.
14. St Lawrence, J.S.; Montano, D.E.; Kasprzyk, D.; Phillips, W.R.; Armstrong, K.
and Leichliter, J.S. STD screening, testing, case reporting, and clinical and
partner notification practices: a national survey of US physicians. Am J Public
Health 2002;92:1784-8
15. Hogben, M.; McCree, D.H. and Golden, M.R. Patient-delivered partner therapy
for sexually transmitted diseases as practiced by U.S. physicians. Sex Transm
Dis 2005;32:101-105
16. Dicker, L.W.; Mosure, D.J.; Berman, S.M. and Levine, W.C. Gonorrhea
prevalence and coinfection with chlamydia in women in the United States, 2000.
Sex Transm Dis 2003;30:472-6
17. Romano, A.; Torres, M.J.; Namour, F., et al. Immediate hypersensitivity to
cephalosporins. Allergy 2002;57:52-7
18. Pichichero, M.E. A review of evidence supporting the American Academy of
Pediatrics recommendation for prescribing cephalosporin antibiotics for penicillinallergic patients. Pediatrics 2005;115:1048-57
19. Pichichero, M.E. Cephalosporins can be prescribed safely for penicillin-allergic
patients. J Fam Pract 2006;55:106-12
20. Kelkar, P.S.; Li, J.T-C. Cephalosporin allergy. N Engl J Med 2001;345:804-809
21. Solensky, R. Drug hypersensitivity. Med Clin North Am 2006;90:233-60
22. Greenberger, P.A.. 8. Drug allergy. J Allergy Clin Immunol 2006;117:S464-70
23. Apter, A.J.; Kinman, J.L.; Bilker, W.B. and et al. Is there cross-reactivity between
penicillins and cephalosporins? Am J Med 2006;119:354.e11-20
24. Gruchalla, R.S.; Pirmohamed, M. Clinical practice. Antibiotic allergy. N Engl J
Med 2006;354:601-9
25. Rubinstein, E. Comparative safety of the different macrolides. Int J Antimicrob
Agents 2001;18:S71-6
Illinois EPT Guidance
Revised: January 7, 2010
Page 13
26. Stekler, J.; Bachmann, L.; Brotman, R.M., et al. Concurrent sexually transmitted
infections (STIs) in sex partners of patients with selected STIs: implications for
patient-delivered partner therapy. Clin Infect Dis 2005;40:787-93
Illinois EPT Guidance
Revised: January 7, 2010
Page 14
Appendix A
URGENT and PRIVATE
IMPORTANT INFORMATION ABOUT YOUR HEALTH
(Treatment Fact Sheet)
TREATMENT FACT SHEET FOR SEX PARTNERS OF PERSONS
WITH CHLAMYDIA
PLEASE READ THIS VERY CAREFULLY.
Your sex partner has recently been treated for chlamydia. Chlamydia is a sexually
transmitted disease (STD) that you can get from having sex (oral, vaginal or anal) with a
person who already has it. You may have been exposed. Chlamydia is easily treated
with the medicine azithromycin (also known as Zithromax). Your partner may have
given you azithromycin (pills) or a prescription for azithromycin. This medicine or
prescription was given to your partner by his/her doctor to treat you.
It is important for you to see your own doctor or clinic provider right away for an
examination. If you cannot get to a doctor in the next several days, you should take the
azithromycin. Even if you decide to take the medicine, it is very important to see a
doctor as soon as you can to get examined and tested for other STDs. People can have
more than one STD at the same time. Azithromycin will not cure other sexually
transmitted infections. Having STDs can increase your risk of getting HIV, so make sure
to also get an HIV test.
SYMPTOMS
Some people infected with chlamydia have symptoms but many DO NOT. If you do
have symptoms they may include the following:
Males can have pain when they urinate (pee), pain in the testicles (balls) or pain
in the lower part of the belly.
Females can have an abnormal vaginal discharge, pain when they urinate, pain
when having sex or vaginal bleeding between periods.
Males and females can have a discharge or pain in the rectum if they’ve had
rectal sex and become infected.
Remember many people with chlamydia do not have symptoms and can spread it
without ever feeling anything is wrong.
BEFORE TAKING THIS MEDICINE
The medicine is very safe; however, DO NOT TAKE if:
Illinois EPT Guidance
Revised: January 7, 2010
Page 15
You are female and have lower belly pain, pain during sex, vomiting or fever.
 You are male and have pain or swelling in the testicles or fever.
 You have ever had a bad reaction, rash, breathing problems, or allergic reaction
after taking azithromycin or other antibiotics. People who are allergic to some
antibiotics may be allergic to other types. If you do have allergies to antibiotics, you
should be examined by your doctor before taking this medicine.
 You have a serious long-term illness, such as kidney, heart or liver disease.

If you are currently taking another prescription medication, including medicine for
diabetes, consult your pharmacist before taking the medication to ask about drug
interactions.
If any of these circumstances exist, or if you are not sure, do not take the azithromycin.
Instead, you should talk to your doctor as soon as possible. Your doctor will find the
best treatment for you.

WARNINGS
 If you do not take medicine to cure chlamydia, you can get very sick. If you are a
woman, you might not be able to have children.
 If you are pregnant, seek medical evaluation before taking the medicine.
HOW TO TAKE THE MEDICINE
 One gram (two pills) of azithromycin is used to treat chlamydia.
 You can take these pills with or without food. However, taking these pills with food
decreases the chance of having an upset stomach and will increase the amount of
medicine your body absorbs.
 You need to take the two pills you were given to be cured.
 Do NOT take antacids (such as Tums, Rolaids, or Maalox) for one hour before or
two hours after taking the azithromycin pills.
 Do NOT share or give this medication to anyone else.
SIDE EFFECTS
Possible side effects include:
 Slightly upset stomach
 Diarrhea
 Dizziness
 Vaginal yeast infection
These are well-known side effects and are not serious. Very few people experience any
of these problems.
ALLERGIC REACTIONS
Allergic reactions are rare. If you have ever had a bad reaction, rash, breathing
problems or other allergic reactions with azithromycin or other antibiotics, consult your
doctor or pharmacy before taking.
Possible serious allergic reactions include:
 Difficulty breathing/tightness in the chest
 Closing of your throat
Illinois EPT Guidance
Revised: January 7, 2010
Page 16


Swelling of your lips or tongue
Hives (bumps or welts on your skin that itch intensely)
If you experience any of these reactions, call 911 or go to the nearest emergency room
immediately!
NEXT STEPS
 Now that you have your medicine, do not have sex for the next seven days after you
have taken the medicine. It takes seven days for the medicine to cure chlamydia. If
you have sex without a condom, or with a condom that breaks, during those first
seven days, you can still pass on the infection to your sex partners. You can also
get re-infected yourself.
 If you think you do have symptoms of a chlamydia infection and they do not go
away within seven days after taking this medicine, please go to a doctor for more
testing and treatment.
 If you have any other sex partners, tell them you are getting treated for chlamydia,
so they can get examined and treated.
 People who get chlamydia once can get it again. It is a good idea to get tested for
all STDs three months from now to be sure you did not get another STD.
 Not having sex is the best protection against chlamydia and other STDs. Having
sex with only one uninfected partner who only has sex with you is also safe.
 The use of latex condoms during sexual intercourse when used consistently and
correctly can reduce the risk of transmission of chlamydia.
 If you have any questions about the medicine, chlamydia or other STDs, please call:
Illinois Department of Public Health’s STD Section (217-782-2747) during
normal business hours or the Department’s STD/HIV hotline (800-2432437).
All calls are confidential.
For more information about chlamydia or other STDs, or to find testing sites in your
area, please visit the Department’s Web site at www.idph.state.il.us.
Illinois EPT Guidance
Revised: January 7, 2010
Page 17
Appendix B
URGENT and PRIVATE
IMPORTANT INFORMATION ABOUT YOUR HEALTH
(Treatment Fact Sheet)
TREATMENT FACT SHEET FOR SEX PARTNERS OF PERSONS
WITH GONORRHEA
PLEASE READ THIS VERY CAREFULLY.
Your sex partner has recently been treated for gonorrhea. Gonorrhea is a sexually
transmitted disease (STD) that you can get from having sex (oral, vaginal or anal) with a
person who already has it. You may have been exposed. Gonorrhea is easily treated
with the medicine cefixime. Your partner may have given you cefixime (pill) or a
prescription for this medication. This medicine or prescription was given to your partner
by his/her doctor to treat you.
It is important for you to see your own doctor or clinic provider right away for an
examination. If you cannot get to a doctor in the next several days, you should take the
cefixime. Even if you decide to take the medicine, it is very important to see a doctor as
soon as you can to get examined and tested for other STDs. People can have more
than one STD at the same time. Cefixime will not cure other sexually transmitted
infections. Having STDs can increase your risk of getting HIV, so make sure to also get
an HIV test.
SYMPTOMS
Some people infected with gonorrhea DO NOT have symptoms. If you do have
symptoms they may include the following:
Males can have pain when they urinate (pee), pain in the testicles (balls) or pain
in the lower part of the belly.
Females can have an abnormal vaginal discharge, painful urination, pain when
having sex or vaginal bleeding between periods.
Males and females can have pain in the throat and a discharge or pain in the
rectum if they’ve had oral or rectal sex and become infected in either of these
sites.
Remember some people with gonorrhea do not have symptoms and can spread it
without ever feeling anything is wrong.
Illinois EPT Guidance
Revised: January 7, 2010
Page 18
BEFORE TAKING THIS MEDICINE
The medicine is very safe; however, DO NOT TAKE if:
 You are female and have lower belly pain, pain during sex, vomiting or fever.
 You are male and have pain or swelling in the testicles or fever.
 You have ever had a bad reaction, rash, breathing problems, or allergic reaction
after taking cefixime or other antibiotics. People who are allergic to some antibiotics
may be allergic to other types. If you do have allergies to antibiotics, you should be
examined by your doctor before taking this medicine.
 You have a serious long-term illness, such as kidney, heart or liver disease.

If you are currently taking another prescription medication, including medicine for
diabetes, consult your pharmacist before taking the medication to ask about drug
interactions.
If any of these circumstances exist, or if you are not sure, do not take the cefixime .
Instead, you should talk to your doctor as soon as possible. Your doctor will find the
best treatment for you.
WARNINGS
 If you performed oral sex on someone who was infected with gonorrhea, the
medicine may not work as well. You need to see a doctor to get stronger medicine.
 If you do not take medicine to cure gonorrhea, you can get very sick. If you are a
woman, you might not be able to have children.
 If you are pregnant, seek medical evaluation before taking the medicine.
HOW TO TAKE THE MEDICINE
 One pill (400 milligrams) of cefixime is used to treat gonorrhea.
 You can take this pill with or without food. However, taking this pill with food
decreases the likelihood of having an upset stomach and will increase the amount
of medicine your body absorbs.
 You need to take the pill you were given to be cured.
 Do NOT take antacids (such as Tums, Rolaids, or Maalox) for one hour before or
two hours after taking the cefixime pill.
 Do NOT share or give this medication to anyone else.
SIDE EFFECTS
Possible side effects include:
 Slightly upset stomach
 Diarrhea
 Dizziness
 Vaginal yeast infection
These are well-known side effects and are not serious. Very few people experience any
of these problems.
ALLERGIC REACTIONS
Allergic reactions are rare. If you have ever had a bad reaction, rash, breathing
problems or other allergic reactions with cefixime or other antibiotics, consult your
doctor or pharmacy before taking.
Illinois EPT Guidance
Revised: January 7, 2010
Page 19
Possible serious allergic reactions include:
 Difficulty breathing/tightness in the chest
 Closing of your throat
 Swelling of your lips or tongue
 Hives (bumps or welts on your skin that itch intensely)
If you experience any of these reactions, call 911 or go to the nearest emergency room
immediately!
NEXT STEPS
 Now that you have your medicine, do not have sex for the next seven days after you
have taken the medicine. It takes seven days for the medicine to cure gonorrhea. If
you have sex without a condom, or with a condom that breaks, during those first
seven days, you can still pass on the infection to your sex partners. You can also
get re-infected yourself.
 If you think you do have symptoms of a gonorrhea infection and they do not go
away within seven days after taking this medicine, please go to a doctor for more
testing and treatment.
 If you have any other sex partners, tell them you are getting treated for gonorrhea,
so they can get examined and treated.
 People who get gonorrhea once can get it again. It is a good idea to get tested for
all STDs three months from now to be sure you did not get another STD.
 Not having sex is the best protection against gonorrhea and other STDs. Having
sex with only one uninfected partner who only has sex with you is also safe.
 The use of latex condoms during sexual intercourse when used consistently and
correctly can reduce the risk of transmission of gonorrhea.
 If you have any questions about the medicine, gonorrhea or other STDs, please
call:
Illinois Department of Public Health’s STD Section (217-782-2747) during
normal business hours or the Department’s STD/HIV hotline (800-2432437).
All calls are confidential.
For more information about gonorrhea or other STDs, or to find testing sites in your
area, please visit the Department’s Web site at www.idph.state.il.us.
Illinois EPT Guidance
Revised: January 7, 2010
Page 20
Appendix C
URGENT and PRIVATE
IMPORTANT INFORMATION ABOUT YOUR HEALTH
(Treatment Fact Sheet)
TREATMENT FACT SHEET FOR SEX PARTNERS OF PERSONS
WITH CHLAMYDIA AND GONORRHEA
PLEASE READ THIS VERY CAREFULLY.
Your sex partner has recently been diagnosed with two sexually transmitted diseases
(STDs). This means you may have been exposed to gonorrhea and chlamydia.
You can get gonorrhea and chlamydia from having any kind of sex (oral, vaginal or
anal) with a person who already has them. The good news is that they are easily
treated.
You are being given two different types of medicine. One is called cefixime (sometimes
known as “Suprax”). It will cure gonorrhea. The other is called azithromycin
(sometimes known as “Zithromax”). It will cure chlamydia. Your partner may have
given you both medicines, or a prescription that you can take to a pharmacy. These
instructions are for how to take cefixime and azithromycin.
The best way to take care of these infections is to see your own doctor or clinic provider
right away. If you can’t get to a doctor in the next several days, you should take both
medicines.
Even if you decide to take the medicines, it is very important to see a doctor as soon as
you can, to get tested for other STDs. You may have been exposed to other STDs that
cefixime and azithromycin will not cure. Having STDs can increase your risk of getting
HIV, so make sure to also get an HIV test.
SYMPTOMS
Some people infected with chlamydia and gonorrhea DO NOT have symptoms. If you
do have symptoms they may include the following:
Males can have pain when they urinate (pee), pain in the testicles (balls) or pain
in the lower part of the belly.
Females can have an abnormal vaginal discharge, painful urination, pain when
having sex or vaginal bleeding between periods.
Illinois EPT Guidance
Revised: January 7, 2010
Page 21
Males and females can have pain in the throat and a discharge or pain in the
rectum if they’ve had oral or rectal sex and become infected in either of these
sites.
Remember some people with gonorrhea do not have symptoms and can spread it
without ever feeling anything is wrong.
BEFORE TAKING THE MEDICINE
Before you take the medicine, please read the following:
The medicines are very safe; however, DO NOT TAKE if:
You are female and have lower belly pain, pain during sex, vomiting or fever
You are male and have pain or swelling in the testicles (balls) or fever
You have one or more painful and swollen joints, or a rash all over your body
You have ever had a bad reaction, rash, breathing problems or allergic reaction
after taking cefixime, azithromycin, or other antibiotics. People who are allergic
to some antibiotics may be allergic to other types. If you do have allergies to
antibiotics, you should check with your doctor before taking these medicines.
You have a serious long-term illness, such as kidney, heart or liver disease.
You are currently taking another prescription medicine, including medicine for
diabetes.
If any of these circumstances exist, or if you are not sure, do not take these medicines.
Instead, you should talk to your doctor as soon as possible. Your doctor will find the
best treatment for you.
WARNINGS
If you performed oral sex on someone who was infected with gonorrhea, the
medicine may not work as well. You need to see a doctor to get stronger
medicine.
If you do not take medicine to cure gonorrhea or chlamydia, you can get very
sick. If you’re a woman, you might not be able to have children.
If you are pregnant, seek medical evaluation before taking the medicine.
HOW TO TAKE THE MEDICINE
Take the medicines with food. This will decrease the chances of having an upset
stomach, and will increase the amount your body absorbs.
You should have one pill of cefixime (400 mg), and two pills of azithromycin (500
mg each). Take all three pills with water at the same time. You need to take all
three pills in order to be cured.
Do NOT take antacids (such as Tums, Rolaids, or Maalox) for one hour before or
two hours after taking the medicines.
Do NOT share or give these medicines to anyone else!
SIDE EFFECTS
You may experience some side effects, including:
Slightly upset stomach
Diarrhea
Illinois EPT Guidance
Revised: January 7, 2010
Page 22
Dizziness
Vaginal yeast infection
These are well-known side effects and are not serious.
ALLERGIC REACTIONS
Very serious allergic reactions include:
Difficulty breathing/tightness in the chest
Closing of your throat
Swelling of your lips or tongue
Hives (bumps or welts on your skin that itch intensely)
If you experience any of these, call 911 or go to the nearest emergency room
immediately!
NEXT STEPS
 Now that you have your medicines, do not have sex for the next seven days after
you have taken the medicines. It takes seven days for the medicine to cure
chlamydia and gonorrhea. If you have sex without a condom, or with a condom that
breaks, during those first seven days, you can still pass on the infections to your sex
partners. You can also get re-infected yourself.
 If you think you do have symptoms of a chlamydia or gonorrhea infection and they
do not go away within seven days after taking this medicine, please go to a doctor
for more testing and treatment.
 If you have any other sex partners, tell them you are getting treated for chlamydia
and gonorrhea, so they can get examined and treated.
 People who get chlamydia and gonorrhea once can get them again. It is a good
idea to get tested for all STDs three months from now to be sure you did not get
another STD.
 Not having sex is the best protection against chlamydia, gonorrhea and other STDs.
Having sex with only one uninfected partner who only has sex with you is also safe.
 The use of latex condoms during sexual intercourse when used consistently and
correctly can reduce the risk of transmission of chlamydia and gonorrhea.
 If you have any questions about the medicine, chlamydia, gonorrhea or other STDs,
please call:
Illinois Department of Public Health’s STD Section (217-782-2747) during
normal business hours or the Department’s STD/HIV hotline (800-2432437).
All calls are confidential.
For more information about chlamydia, gonorrhea or other STDs, or to find testing sites
in your area, please visit the Department’s Web site at www.idph.state.il.us.
Illinois EPT Guidance
Revised: January 7, 2010
Page 23
Appendix D
URGENTE y PRIVADO
INFORMACIÓN IMPORTANTE ACERCA DE SU SALUD
(Hoja de información básica sobre el tratamiento)
HOJA DE INFORMACIÓN BÁSICA SOBRE EL TRATAMIENTO PARA LAS
PAREJAS SEXUALES DE PERSONAS CON CLAMIDIA
FAVOR DE LEER ESTO CON MUCHO CUIDADO.
Tu pareja sexual recientemente se hizo un tratamiento para combatir la clamidia. La
clamidia es una enfermedad de transmisión sexual que puedes contraer por tener
relaciones sexuales (orales, vaginales o anales) con una persona que ya la tiene. Es
posible que tú hayas estado expuesto(a). La clamidia se trata fácilmente con una
medicina llamada acitromicina (también conocida como Zithromax). Es posible que tu
pareja te haya dado acitromicina (pastillas) o una receta para adquirir la acitromicina. El
doctor de tu pareja le dio esta medicina o receta médica para que tú te trates.
Es importante que visites a tu médico o acudas a tu clínica cuanto antes para que te
hagan exámenes. Si no puedes ir al doctor en los próximos días, debes tomar la
acitromicina. Incluso si decides tomar la medicina, es muy importante que veas al
doctor en cuanto puedas para que te hagan exámenes para detectar otras ETS. Las
personas pueden tener más de una ETS al mismo tiempo. La acitromicina no cura otras
enfermedades de transmisión sexual. Padecer una o más ETS puede incrementar el
riesgo de que contraigas el VIH, así que asegúrate de que te practiquen también un
examen de VIH.
SÍNTOMAS
Algunas personas con clamidia tienen síntomas, pero muchas NO LOS TIENEN. Si
tienes síntomas, puedes presentar algunos de éstos:
Los hombres pueden tener dolor cuando orinan (hacen pipí), dolor en los
testículos o dolor en la parte baja del vientre.
Las mujeres pueden tener un flujo vaginal anormal, dolor al orinar, dolor al tener
relaciones sexuales o sangrado vaginal entre sus periodos menstruales.
Los hombres y las mujeres pueden tener un flujo o dolor en el recto si ellos han
tenido sexo rectal y llegan a ser infectado.
Illinois EPT Guidance
Revised: January 7, 2010
Page 24
Recuerda que muchas personas con clamidia no tienen síntomas y pueden propagarla
si haber sentido nunca algo malo.
ANTES DE TOMAR ESTA MEDICINA
Esta medicina es muy segura; sin embargo, NO TE LA TOMES si:
 Eres mujer y tienes dolor en el bajo vientre o experimentas dolor durante el acto
sexual; tienes vómito o fiebre.
 Eres hombre y tienes dolor o inflamación en los testículos o fiebre.
 Has tenido alguna mala reacción, como erupción, problemas respiratorios o
reacción alérgica, después de tomar acitromicina u otros antibióticos. Las personas
que son alérgicas a algún antibiótico pueden ser alérgicas a otros tipos de
antibiótico. Si eres alérgico a los antibióticos, tu doctor debe examinarte antes de
que te tomes esta medicina.
 Tienes una enfermedad grave de larga duración, tal como afecciones del riñón, el
corazón o el hígado.

Si actualmente estás tomando otras medicinas que te hayan recetado, incluyendo
medicamentos para la diabetes, consulta a tu farmaceuta antes de tomarte la
medicina para que te diga qué interacción tiene con otros medicamentos.
Si existe cualquiera de estas circunstancias, o si no estás seguro(a), no te tomes la
acitromicina. Mejor, habla con tu medico lo más pronto posible. Tu médico encontrará
el mejor tratamiento para ti.
PRECAUCIONES
 Si no tomas medicamentos para curarte la clamidia, te puedes enfermar muy
gravemente. Si eres mujer, probablemente no puedas tener hijos.
 Si estás embarazada, consulta a tu médico antes de tomarte esta medicina.
CÓMO TOMAR LA MEDICINA
 Se usa un gramo (dos pastillas) de acitromicina para tratar la clamidia.
 Puedes tomarte estas pastillas con o sin alimentos. Sin embargo, tomarte estas
pastillas con los alimentos disminuye las probabilidades de que tengas malestar
estomacal e incrementa la cantidad de medicamento que absorbe tu cuerpo.
 Necesitas tomarte las dos pastillas que se te dieron para curarte.
 NO tomes antiácidos (como Tums, Rolaids o Melox) una hora antes ni dos horas
después de tomarte las pastillas de acitromicina.
 NO compartas esta medicina con nadie ni se la des a nadie más.
EFECTOS COLATERALES
Entre los efectos colaterales pueden estar:
 Malestar estomacal leve.
 Diarrea
 Mareo
 Infección vaginal por levaduras.
Éstos son efectos colaterales bien conocidos y no son graves. Muy pocas personas
experimentan algunos de estos problemas.
Illinois EPT Guidance
Revised: January 7, 2010
Page 25
REACCIONES ALÉRGICAS
Las reacciones alérgicas son raras. Si has tenido una mala reacción, erupción,
problemas respiratorios u otras reacciones alérgicas con la acitromicina u otros
antibióticos, consulta a tu médico o farmaceuta antes de tomártela.
Entre las reacciones alérgicas graves se encuentran:
 Dificultad para respirar / opresión en el pecho
 Que se te cierre la garganta
 Inflamación de los labios o la lengua
 Urticaria (ronchas o verdugones en la piel que producen comezón intensa)
Si experimentas cualquiera de estas situaciones, llama al 911 o acude de inmediato al
hospital o centro de emergencias más cercano.
SIGUIENTES PASOS
Ahora que tienes tus medicinas, no tengas relaciones sexuales durante los
siguientes siete días después de que te hayas tomado las medicinas. Las
medicinas tardan siete días en curar la gonorrea y la clamidia. Si tienes
relaciones sexuales sin condón, o con un condón que se rompa, durante esos
primeros siete días, todavía puedes contagiarles estas infecciones a tus parejas
sexuales. También puedes volver a infectarte.
Si piensas que tienes síntomas de una infección por clamidia y no desaparecen
en siete días después de tomar estas medicinas, por favor consulta tu médico
para que te haga más exámenes y te dé otro tratamiento.
Si tienes otras parejas sexuales, diles que te estás tratando la gonorrea y la
clamidia, para que también sigan un tratamiento.
Las personas que se infectan con gonorrea y clamidia una vez tienen una
probabilidad muy alta de volverse a infectar. Es buena idea hacerte exámenes
de gonorrea, clamidia y otras ETS dentro de tres meses para que estés
seguro(a) de que no contrajiste otra infección.
No tener relaciones sexuales es la mejor protección contra clamidia, gonorrea y
otras ETS. Tener relaciones sexuales únicamente con una pareja que no esté
infectada y que sólo tenga relaciones contigo también es seguro.
El uso de condones de látex durante el acto sexual cuando se usan siempre y de
manera correcta puede disminuir el riesgo de transmisión de clamidia y
gonorrea.
Si tienes alguna pregunta sobre el medicamento, la clamidia u otras ETS, por
favor llama a:
Departamento de Salud Pública de Illinois, Sección de ETS (217-782-2747)
en horas hábiles, o llama a la línea de emergencia (hotline) de ETS/VIH del
Departamento (800-243-2437).
Todas las llamadas son confidenciales.
Para obtener más información acerca de la clamidia o cualquier otra ETS, o bien para
encontrar lugares a los que puedas acudir para hacerte exámenes, por favor visita el
sitio de Internet del Departamento en www.idph.state.il.us.
Illinois EPT Guidance
Revised: January 7, 2010
Page 26
Appendix E
URGENTE y PRIVADO
INFORMACIÓN IMPORTANTE ACERCA DE SU SALUD
(Hoja de información básica sobre el tratamiento)
HOJA DE INFORMACIÓN BÁSICA SOBRE EL TRATAMIENTO PARA LAS
PAREJAS SEXUALES DE PERSONAS CON GONORREA
FAVOR DE LEER ESTO CON MUCHO CUIDADO.
Tu pareja sexual recientemente se hizo un tratamiento para combatir la gonorrea. La
gonorrea es una enfermedad de transmisión sexual que puedes contraer por tener
relaciones sexuales (orales, vaginales o anales) con una persona que ya la tiene. Es
posible que tú hayas estado expuesto(a). La gonorrea se trata fácilmente con una
medicina llamada cefixima. Es posible que tu pareja te haya dado una pastilla de
cefixima o una receta para adquirir la cefixima. El doctor de tu pareja le dio esta
medicina o la receta para que tú te trates.
Es importante que visites a tu médico o acudas a tu clínica cuanto antes para que te
hagan exámenes. Si no puedes ir al doctor en los próximos días, debes tomar la
cefixima. Incluso si decides tomar la medicina, es muy importante que veas al doctor en
cuanto puedas para que te hagan exámenes para detectar otras ETS. Las personas
pueden tener más de una ETS al mismo tiempo. La cefixima no cura otras
enfermedades de transmisión sexual. Padecer una o más ETS puede incrementar el
riesgo de que contraigas el VIH, así que asegúrate de que te practiquen también un
examen de VIH.
SÍNTOMAS
Algunas personas que están infectadas de gonorrea NO TIENEN síntomas. Si tienes
síntomas, puedes presentar algunos de éstos:
Los hombres pueden tener dolor cuando orinan (hacen pipí), dolor en los
testículos o dolor en la parte baja del vientre.
Las mujeres pueden presentar un flujo vaginal anormal, dolor al orinar, dolor al
tener relaciones sexuales o sangrado vaginal entre los periodos menstruales.
Los hombres and las mujeres pueden tener dolor en la garganta y un flujo o
dolor en el recto si ellos han tenido sexo oral o rectal y llegan a ser infectado en
cualquiera de estos sitios.
Illinois EPT Guidance
Revised: January 7, 2010
Page 27
Recuerda que algunas personas con gonorrea no tienen síntomas y pueden propagarla
sin haber sentido nunca algo malo.
ANTES DE TOMAR ESTA MEDICINA
Esta medicina es muy segura; sin embargo, NO TE LA TOMES si:
 Eres mujer y tienes dolor en el bajo vientre o experimentas dolor durante el acto
sexual; tienes vómito o fiebre.
 Eres hombre y tienes dolor o inflamación en los testículos o fiebre.
 Has tenido alguna mala reacción, como erupción, problemas respiratorios o
reacción alérgica, después de tomar la cefixima u otros antibióticos. Las personas
que son alérgicas a algún antibiótico pueden ser alérgicas a otros tipos de
antibiótico. Si eres alérgico a los antibióticos, tu doctor debe examinarte antes de
que te tomes esta medicina.
 Tienes una enfermedad grave de larga duración, tal como afecciones del riñón, el
corazón o el hígado.

Si actualmente estás tomando otras medicinas que te hayan recetado, incluyendo
medicamentos para la diabetes, consulta a tu farmaceuta antes de tomarte la
medicina para que te diga qué interacción tiene con otros medicamentos.
Si existe cualquiera de estas circunstancias, o si no estás seguro(a), no te tomes la
cefixima. Mejor, habla con tu medico lo más pronto posible. Tu médico encontrará el
mejor tratamiento para ti.
PRECAUCIONES
 Si practicaste el sexo oral con alguien que estuviera infectado(a) con gonorrea, es
posible que la medicina no funcione bien. Necesitas consultar a un médico para
que te recete un medicamento más fuerte.
 Si no tomas medicamentos para curarte la gonorrea, te puedes enfermar muy
gravemente. Si eres mujer, probablemente no puedas tener hijos.
 Si estás embarazada, consulta a tu médico antes de tomarte esta medicina.
CÓMO TOMAR LA MEDICINA
 Se usan una pastilla (400 miligramos) de cefixima para tratar la gonorrea.
 Puedes tomarte esta pastilla con o sin alimentos. Sin embargo, tomarte esta pastilla
con los alimentos disminuye las probabilidades de que tengas malestar estomacal
e incrementa la cantidad de medicamento que absorbe tu cuerpo.
 Necesitas tomarte la pastilla que se te dieron para curarte.
 NO tomes antiácidos (como Tums, Rolaids o Melox) una hora antes ni dos horas
después de tomarte la pastilla de cefixima.
 NO compartas esta medicina con nadie ni se la des a nadie más.
EFECTOS COLATERALES
Entre los efectos colaterales pueden estar:
 Malestar estomacal leve
 Diarrea
 Mareo
 Infección vaginal por levaduras
Illinois EPT Guidance
Revised: January 7, 2010
Page 28
Éstos son efectos colaterales bien conocidos y no son graves. Muy pocas personas
experimentan algunos de estos problemas.
REACCIONES ALÉRGICAS
Las reacciones alérgicas son raras. Si has tenido una mala reacción, erupción,
problemas respiratorios u otras reacciones alérgicas con la cefixima u otros antibióticos,
consulta a tu médico o farmaceuta antes de tomártela.
Entre las reacciones alérgicas graves se encuentran:
 Dificultad para respirar / opresión en el pecho
 Que se te cierre la garganta
 Inflamación de los labios o la lengua
 Urticaria (ronchas o verdugones en la piel que producen comezón intensa)
Si experimentas cualquiera de estas situaciones, llama al 911 o acude de inmediato al
hospital o centro de emergencias más cercano.
SIGUIENTES PASOS
Ahora que tienes tus medicinas, no tengas relaciones sexuales durante los
siguientes siete días después de que te hayas tomado las medicinas. Las
medicinas tardan siete días en curar la gonorrea y la clamidia. Si tienes
relaciones sexuales sin condón, o con un condón que se rompa, durante esos
primeros siete días, todavía puedes contagiarles estas infecciones a tus parejas
sexuales. También puedes volver a infectarte.
Si piensas que tienes síntomas de una infección por gonorrea y no desaparecen
en siete días después de tomar estas medicinas, por favor consulta tu médico
para que te haga más exámenes y te dé otro tratamiento.
Si tienes otras parejas sexuales, diles que te estás tratando la gonorrea y la
clamidia, para que también sigan un tratamiento.
Las personas que se infectan con gonorrea y clamidia una vez tienen una
probabilidad muy alta de volverse a infectar. Es buena idea hacerte exámenes
de gonorrea, clamidia y otras ETS dentro de tres meses para que estés
seguro(a) de que no contrajiste otra infección.
No tener relaciones sexuales es la mejor protección contra clamidia, gonorrea y
otras ETS. Tener relaciones sexuales únicamente con una pareja que no esté
infectada y que sólo tenga relaciones contigo también es seguro.
El uso de condones de látex durante el acto sexual cuando se usan siempre y de
manera correcta puede disminuir el riesgo de transmisión de clamidia y
gonorrea.
Si tienes alguna pregunta sobre el medicamento, la gonorrea u otras ETS, por
favor llama a:
Departamento de Salud Pública de Illinois, Sección de ETS (217-782-2747)
en horas hábiles, o llama a la línea de emergencia (hotline) de ETS/VIH del
Departamento (800-243-2437).
Todas las llamadas son confidenciales.
Illinois EPT Guidance
Revised: January 7, 2010
Page 29
Para obtener más información acerca de la gonorrea o cualquier otra ETS, o bien para
encontrar lugares a los que puedas acudir para hacerte exámenes, por favor visita el
sitio de Internet del Departamento en www.idph.state.il.us.
Illinois EPT Guidance
Revised: January 7, 2010
Page 30
Appendix F
URGENTE y PRIVADO
INFORMACIÓN IMPORTANTE ACERCA DE TU SALUD
(Hoja de información básica sobre el tratamiento)
INSTRUCCIONES PARA LAS PAREJAS SEXUALES DE PERSONAS
CON CLAMIDIA Y GONORREA
FAVOR DE LEER ESTO CON MUCHO CUIDADO.
Recientemente se le diagnosticó a tu pareja sexual con dos enfermedades de
transmisión sexual (ETS). Esto significa que es posible que tú hayas estado
expuesto(a) a la gonorrea y la clamidia.
Puedes contraer gonorrea y clamidia al tener cualquier tipo de relaciones sexuales
(orales, vaginales o anales) con una persona que ya tenga estas enfermedades. La
buena noticia es que es fácil tratarlas.
Se te están dando dos tipos diferentes de medicinas. Una se llama cefixima (algunas
veces se le conoce como “Suprax”). Ésta cuarará la gonorrea. La otra se llama
acitromicina (algunas veces se le conoce como “Zithromax”). Ésta cuarará la clamidia.
Es posible que tu pareja te haya dado ambos medicamentos, o una receta que puedes
surtir en una farmacia. Estas instrucciones son para que sepas cómo tomar la cefixima
y la acitromicina.
La major manera de cuidarte para combatir estas infecciones es consultar a tu médico
o acudir a tu clínica inmediatamente. Si no puedes ir al doctor en los próximos días,
debes tomar ambas medicinas.
Incluso si decides tomar las medicinas, es muy importante que veas al doctor en cuanto
puedas, para que te hagan exámenes para detectar otras ETS. Es possible que hayas
estado expuesto (a) a otras ETS que la cefixima y la acitromicina no puedan curar.
Padecer una o más ETS puede incrementar el riesgo de que contraigas el VIH, así que
asegúrate de que te practiquen también un examen de VIH.
SÍNTOMAS
Algunas personas que están infectadas de gonorrea NO TIENEN síntomas. Si tienes
síntomas, puedes presentar algunos de éstos:
Los hombres pueden tener dolor cuando orinan (hacen pipí), dolor en los
testículos o dolor en la parte baja del vientre.
Illinois EPT Guidance
Revised: January 7, 2010
Page 31
Las mujeres pueden presentar un flujo vaginal anormal, dolor al orinar, dolor al
tener relaciones sexuales o sangrado vaginal entre los periodos menstruales.
Los hombres and las mujeres pueden tener dolor en la garganta y un flujo o
dolor en el recto si ellos han tenido sexo oral o rectal y llegan a ser infectado en
cualquiera de estos sitios.
Recuerda que algunas personas con gonorrea no tienen síntomas y pueden propagarla
sin haber sentido nunca algo malo.
ANTES DE TOMAR LA MEDICINA
Antes de tomar la medicina, por favor lee lo siguiente:
Las medicinas son muy seguras; sin embargo, NO TE LAS TOMES si:
Eres mujer y tienes dolor en el bajo vientre o experimentas dolor durante el acto
sexual; tienes vómito o fiebre.
Eres hombre y tienes dolor o inflamación en los testículos o fiebre.
Te duelen una o más articulaciones y las tienes inflamadas, o bien tienes una
erupción en todo el cuerpo.
Has tenido alguna mala reacción, como erupción, problemas respiratorios o
reacción alérgica, después de tomar cefixima, acitromicina u otros antibióticos.
Las personas que son alérgicas a algún antibiótico pueden ser alérgicas a otros
tipos de antibiótico. Si eres alérgico a los antibióticos, debes preguntarle al
doctor antes de tomarte estas medicinas.
Tienes una enfermedad grave de larga duración, tal como afecciones del riñón,
el corazón o el hígado.
Estás tomando otro medicamento que te hayan recetado, incluyendo
medicamentos para la diabetes.
Si existe cualquiera de estas circunstancias, o si no estás seguro(a), no te tomes estas
medicinas. Mejor, habla con tu medico lo más pronto posible. Tu médico encontrará el
mejor tratamiento para ti.
PRECAUCIONES
Si practicaste el sexo oral con alguien que estuviera infectado(a) con gonorrea,
es posible que la medicina no funcione bien. Necesitas consultar a un médico
para que te recete un medicamento más fuerte.
Si no tomas medicamentos para curarte la gonorrea o la clamidia, te puedes
enfermar muy gravemente. Si eres mujer, probablemente no puedas tener hijos.
Si estás embarazada, consulta a tu médico antes de tomarte esta medicina.
CÓMO TOMAR LA MEDICINA
Tómate las medicinas junto con los alimentos. Esto disminuirá la probabilidad
de tener malestar estomacal e incrementará la cantidad de medicamento que
absorbe tu cuerpo.
Debes tomarte una pastilla de cefixima (400 mg) y dos pastillas de acitromicina
(cada una de 500 mg). Tómate las tres pastillas con agua al mismo tiempo.
Necesitas tomarte las tres pastillas para curarte.
Illinois EPT Guidance
Revised: January 7, 2010
Page 32
NO tomes antiácidos (como Tums, Rolaids o Melox) una hora antes ni dos horas
después de tomarte las medicinas.
NO compartas estas medicinas con nadie ni se las des a nadie más.
EFECTOS COLATERALES
Puedes experimentar algunos efectos colaterales como:
Malestar estomacal leve
Diarrea
Mareo
Infección vaginal por levaduras
Éstos son efectos colaterales bien conocidos y no son graves.
REACCIONES ALÉRGICAS
Entre las reacciones alérgicas graves se encuentran:
Dificultad para respirar / opresión en el pecho
Que se te cierre la garganta
Inflamación de los labios o la lengua
Urticaria (ronchas o verdugones en la piel que producen comezón intensa)
Si experimentas cualquiera de estas situaciones, llama al 911 o acude de inmediato al
hospital o centro de emergencias más cercano.
SIGUIENTES PASOS
Ahora que tienes tus medicinas, no tengas relaciones sexuales durante los
siguientes siete días después de que te hayas tomado las medicinas. Las
medicinas tardan siete días en curar la gonorrea y la clamidia. Si tienes
relaciones sexuales sin condón, o con un condón que se rompa, durante esos
primeros siete días, todavía puedes contagiarles estas infecciones a tus parejas
sexuales. También puedes volver a infectarte.
Si piensas que tienes síntomas de una infección por gonorrea o clamidia y no
desaparecen en siete días después de tomar estas medicinas, por favor consulta
tu médico para que te haga más exámenes y te dé otro tratamiento.
Si tienes otras parejas sexuales, diles que te estás tratando la gonorrea y la
clamidia, para que también sigan un tratamiento.
Las personas que se infectan con gonorrea y clamidia una vez tienen una
probabilidad muy alta de volverse a infectar. Es buena idea hacerte exámenes
de gonorrea, clamidia y otras ETS dentro de tres meses para que estés
seguro(a) de que no contrajiste otra infección.
No tener relaciones sexuales es la mejor protección contra clamidia, gonorrea y
otras ETS. Tener relaciones sexuales únicamente con una pareja que no esté
infectada y que sólo tenga relaciones contigo también es seguro.
El uso de condones de látex durante el acto sexual cuando se usan siempre y de
manera correcta puede disminuir el riesgo de transmisión de clamidia y
gonorrea.
Si tienes alguna pregunta sobre el medicamento, la gonorrea, la clamidia u otras
ETS, por favor llama a:
Illinois EPT Guidance
Revised: January 7, 2010
Page 33
Departamento de Salud Pública de Illinois, Sección de ETS (217-782-2747)
en horas hábiles, o llama a la línea de emergencia (hotline) de ETS/VIH del
Departamento (800-243-2437).
Todas las llamadas son confidenciales.
Para obtener más información acerca de la gonorrea, la clamidia o cualquier otra ETS,
o bien para encontrar lugares a los que puedas acudir para hacerte exámenes, por
favor visita el sitio de Internet del Departamento en www.idph.state.il.us.
Illinois EPT Guidance
Revised: January 7, 2010
Page 34
Appendix G
URGENT and PRIVATE
IMPORTANT INFORMATION ABOUT YOUR HEALTH
FACT SHEET ABOUT REPEATEDLY ACQUIRING SEXUALLY
TRANSMITTED DISEASES (STD)
You have been diagnosed and treated for an STD more than once. Repeat STDs
(getting the same infection more than once) often occurs by having sex with the same
sex partner who has not been treated. Repeat STDs or getting different STDs can
place you at greater risk for:
Acquiring HIV from an infected sexual partner;
Developing complications from STDs, for example:
o If you are a woman, depending upon the STD, inability to have children,
chronic pelvic pain, cervical cancer, miscarriage if you are pregnant,
medical complications with a newborn, psychological problems from
incurable STDs, etc.
o If you are a man, depending upon the STD, inability to have children,
cancer of the penis, psychological problems resulting from incurable
STDs, etc.
Unknowingly spreading the STD to other members of your community.
You can reduce your risk of acquiring another STD by:
 Making sure your sex partner gets treated for the STD you have;
 Being abstinent, that is, not having sex;
 Practicing monogamy, that is, having sex with only one partner who does not
have an STD;
 Using condoms correctly every time you have sex;
 If you have multiple partners, reducing the number of partners you have;
 Expressing affection other than through intercourse, for example, touching,
kissing, masturbation, etc.; and
 Being tested on a regular basis for HIV and STDs.
Illinois EPT Guidance
Revised: January 7, 2010
Page 35
Appendix H
URGENTE y PRIVADO
INFORMACIÓN IMPORTANTE ACERCA DE SU SALUD
HOJA DE INFORMACIÓN BÁSICA SOBRE LA ADQUISICIÓN
REPETIDA DE ENFERMEDADES DE TRANSMISIÓN SEXUAL (ETS)
Se te ha diagnosticado una ETS más de una vez y se te ha dado tratamiento para ello.
La adquisición repetida de una ETS (contraer la misma infección más de una vez) por
lo general se presenta cuando se tienen relaciones sexuales con la misma pareja y
ésta no ha recibido un tratamiento. Repetir las ETS o contraer diferentes ETS puede
ponerte en mayor riesgo de:
Contagiarte de VIH de una pareja infectada
Desarrollar complicaciones a raíz de las ETS, como por ejemplo:
o Si eres mujer, dependiendo de la ETS, incapacidad para tener hijos, dolor
pélvico crónico, cáncer cervical, aborto natural si estás embarazada,
complicaciones médicas con un recién nacido, problemas psicológicos
causados por una ETS incurable, etc.
o Si eres hombre, dependiendo de la ETS, incapacidad para tener hijos,
cáncer del pene, problemas psicológicos causados por una ETS
incurable, etc.
Propagar, sin saberlo, la ETS entre otros miembros de tu comunidad
Puedes reducir el riesgo de contraer otra ETS si:
 Te aseguras de que tu pareja sexual se haga un tratamiento para la ETS que tú
tienes;
 Te abstienes, es decir, no tienes relaciones sexuales;
 Practicas la monogamia, es decir, tienes relaciones sexuales únicamente con
una sola pareja sexual que no tenga ninguna ETS;
 Usas condón de forma correcta cada vez que tienes relaciones sexuales;
 En caso de tener parejas múltiples, reduces el número de parejas que tienes;
 Expresas tu cariño de otras maneras y no sólo con la relación completa, por
ejemplo, tocando, besando, mediante la masturbación, etc.; y
 Hacerte exámenes para detectar el VIH y otras ETS en forma regular.
Illinois EPT Guidance
Revised: January 7, 2010
Page 36