A Washington state program that gives people with chlamydia or gonorrhea free antibiotics to treat their partners boosted access to the drugs and may have reduced rates of sexually transmitted infections.
The intervention, outlined in a study published Thursday in the journal PLOS Medicine, appeared to approximately double the likelihood that sex partners could be treated without going to the doctor.
“We think about 50 percent of heterosexuals with gonorrhea or chlamydia were offered medications to give to their sex partners and about one-third received them,” said Dr. Matthew Golden, director of the HIV/STD program at Public Health — Seattle & King County.
The effort appeared to cut rates of the potentially dangerous sexually transmitted diseases (STDs) by about 10 percent, though the drop wasn’t statistically significant and must be confirmed in larger studies.
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The study included data from 23 health jurisdictions in the state from October 2007 to August 2009. The sites were randomly assigned in six- to eight-month waves where health-care providers would hand out free antibiotics to patients to give to up to three sex partners. Or they’d provide prescriptions for the partners to be filled for free at cooperating pharmacies. Also, health-department staff offered to help notify the partners that they’d been exposed to the sexually transmitted infections, or STIs.
“It’s the only community-level trial to date to look at, ‘Can an intervention decrease STIs at a population level?’” Golden said. “To date, no one has replicated what we’re doing.”
Nearly 20,000 drug packs were delivered to about 500 clinics and pharmacies. By the end of the trial, the proportion of patients receiving free drugs jumped from 18 percent to 34 percent, and the percentage receiving partner services rose from 25 to 45 percent, the study found.
The intervention demonstrated a level of use of what’s known as “expedited partner therapy” or EPT, about five times higher than other places in the U.S., Golden said. That makes the program a model for reducing gonorrhea and chlamydia, which can go undiagnosed and untreated, impairing fertility and causing other health problems.
In 2013, about 1.4 million people in the U.S. were infected with chlamydia, and about 333,000 had gonorrhea, according to federal statistics. In Washington, there were about 25,000 chlamydia and 4,390 gonorrhea cases that year.
The study fuels evidence for proposed guidelines from the Centers for Disease Control and Prevention (CDC) that call for health-care providers to routinely offer the expedited treatment to heterosexual patients with the two common STIs — as long as it’s legal.
“It’s most useful when the partner is unlikely to seek care and not likely to be treated,” explained Matthew Hogben, chief of social and behavioral research in the CDC’s STD prevention division.
EPT is legal in 35 states and potentially allowable in nine, but prohibited in six, typically because of laws barring doctors from prescribing drugs without examining a patient.
Despite those laws, the CDC has recommended EPT since 2006, with guidelines updated in 2010, Hogben said. The new proposed guidelines are based on evidence that in a meta-analysis of several trials, so-called “patient-delivered partner therapy” can cut chlamydia rates by 20 percent and gonorrhea by 50 percent.
The practice has continued to thrive in Washington since the study ended, Golden said. “Patients want it,” he said.
For the trial, the drugs were provided free by manufacturer Pfizer and local pharmacies. Golden said he’d like to see them made widely available just as vaccines are available to ensure children are immunized. “If we say that STDs are a public-health problem, we should purchase the medications together,” he said. “We feel that partner treatment should be like that.”