1. Sexually Transmitted Infections (STI) AND Expedited Partner Treatment (EPT)
Mayuri Dasari M.D.
Cook County Loyola Provident
Family Medicine Residency Program

2. GOALS
Discuss and Educate health care providers on Sexually Transmitted Infections (STI) and Expedited Partner Treatment (EPT), to decrease the rate of re- infection in the community

3. OBJECTIVES Awareness of the laws/regulations regarding EPT
Interpret biostatistics of testing methods used in diagnosing STI
Know the different treatment options of EPT
List at least two alternative treatments for pregnant patients

4. Expedited Partner Treatment (EPT)
It is the practice of treating partners of persons with STI without an intervening medical evaluation or professional prevention counseling.
Implementation of EPT is primarily through patient delivered partner treatment (PDPT)
RCT funded by CDC revealed decrease in re- infection rates with EPT compared to other methods

5. Laws regarding EPT EPT is permissible in 32 states
EPT is potentially allowable in 11 states
EPT is prohibited in 7 states
See Handout For details

7. STI
According to 2010 CDC estimations, the most troubling trends were seen in the three most treatable STI in the US
Gonorrhea
Chlamydia
Syphilis

8. STI Trichomoniasis Symptoms more prominent in women compared to men
Increased risk of SGA and premature delivery

9. Gonorrhea Constant Fluctuation of prevalence rate Susceptibility -
Ciprofloxacin - 6% - 8% from 2009 to 2011
Azithroymycin - MSM (EPT not recommended in MSM)

12. Chlamydia
The most commonly reported notifiable disease in the United States, per the CDC
Highest prevalence by sex, in young women (especially age ), which could be a reflection of screening recommendations.
Highest prevalence by race is seen in African- Americans

15. Trichomoniasis
Trend data for this infection are limited to estimates of initial physician visits from the NDTI (National Disease and Therapeutic Index)
The highest prevalence is noticed among blacks at 13% per CDC
The overall prevalence in 2004 was 3%

17. Testing methods of GC/CT and Trichomoniasis
Urethral swab, Endo-cervical swab, and Urine assay
Trichomoniasis
Wet mount, Culture, and PCR

18. Chlamydia Sensitivity Specificity Urethral swab 95.9% 97.5%
Endocervical swab
94.2%
97.6%
Urine assay (Male)
97.9%
98.5%
Urine assay (Female)
94.7%
98.9%

19. Gonorrhea Sensitivity Specificity Urethral swab 99.1% 97.8%
Endocervical swab
99.2%
98.7%
Urine assay (Male)
98.5%
99.6%
Urine assay (Female)
91.3%
99.3%

20. Trichomoniasis Sensitivity Specificity Wet Mount 56% 100% Culture 83%
PCR
98.2%
98%

21. Treatment Options for EPT
Chlamydia
Gonorrhea
Trichomoniasis*
*Trichomoniasis is not part of EPT, per CDC

22. Treatment in NonPregnant Patients Treatment in Pregnant Patients
Chlamydia
Azithromycin 1g PO x 1
Doxycycline 100 PO BID x 7
Azithromycin 1 g PO x 1
Amoxicillin 500mg PO TIDx7
Erythromycin 500mg PO QID
Gonorrhea
Ceftriaxone 250 mg IM x 1
Cefixime 400 mg PO x 1
Trichomoniasis
Metronidazole 500 mg PO BID x 7
Metronidazole 2 g PO x 1

23. Pregnancy Trichomoniasis -
Delaying treatment in pregnancy is recommended until after first trimester * (per ACOG Guidelines Vs Expert)
CDC recommends treating pregnant women regardless of their gestational age.

24. Re-Testing in Pregnancy
CDC recommends testing for re-infection within 3 to 4 weeks after completion of treatment
Patient’s sex partners from the preceding 60 days need to be promptly evaluated and treated
ACOG recommends following CDC guidelines for treatments and test of cure
Abstinence until 7 days after completion of treatment of patient and partner

25. Re-Testing in NonPregnant Patients
Gonorrhea -
Re-test in 1 week all patients treated with alternative treatment methods
Increase in resistance to alternative oral treatment

26. Summary Trend of increase in prevalence of GC/CT infections
EPT is permissible in 32 states including Illinois
Sensitivity and Specificity is higher with Urine PCR
Primary treatment options for common STIs
Alternative treatment options are available for Chlamydia and Gonorrhea in pregnant and non pregnant patients
Re-testing for Gonorrhea and Chlamydia in pregnant and non pregnant patients

27. Small Group Discussion

28. Case 1 - Discussion Urine Hcg
Ceftriaxone 250 mg IM x1 AND Azithromycin 1 g PO x 1
Azithromycin 1 g PO x 1 AND Cefixime 400 mg PO x 1
Retest partner in 1 week due to increased resistance to oral treatments for Gonorrhea
Safe sex education, abstinence until 7 days after completion of treatment

29. Case 2 - Discussion Prenatal labs, ultrasound, counseling
Azithromycin 1 g PO x 1, OR Amoxicillin 500 mg PO TID x 7 days, OR Erythromycin 500 mg PO QID x 7 days
AND Ceftriaxone 250 mg IM x 1 or Cefixime 400 mg PO x 1
Partner - Azithromycin 1 g PO x 1 AND Cefixime 400 mg PO x 1
Test of cure for patient in 3 to 4 weeks
Retest partner 1 week after treatment completion

30. Case 3 - Discussion HIV, RPR, Hep B, Hep C Azithromycin 1 g PO x 1
Cannot give partner treatment because she lives in a state where EPT is prohibited
No need for retesting the patient if he received Ceftriaxone IM