Expedited Partner Therapy in Female Adolescents: A Study of Acceptance and the Impact on Reinfection Rates

Abstract

Background: Given the high risk of sexually transmitted infections (STIs) in adolescents and young adults (AYAs), this study evaluated expedited partner therapy (EPT) acceptance and STI reinfection rates in female AYA before and after availability of EPT. Methods:The pre-EPT cohort was a 3-year (November 2012 to November 2015) retrospective chart review of female AYA positive for Chlamydia trachomatis (CT) and/or Trichomonas vaginalis (TV) before introduction of EPT. An EPT protocol for CT and TV infections was implemented after legalization in Ohio in 2016. The post-EPT cohort was a prospective review of patients positive for CT and TV for 2 years (5/2016-5/2018) after EPT introduction. We evaluated EPT acceptance and compared reinfection rates (positive test 1-6 months after initial infection) in the pre-EPT versus post-EPT cohorts and by EPT acceptance.Results: Among patients offered EPT, 28% (67/237) with CT and 25% (24/97) with TV accepted EPT. There were no significant differences in the reinfection rates for CT or TV in the pre-EPT versus post-EPT cohorts (CT: 24% (57/240) vs 20% (38/192), P = 0.42; TV: 23% (22/97) versus 14% (12/87), P = 0.11). Although lower, reinfections rates were not significantly different among patients who accepted versus did not accept EPT (CT, 13% (6/48) vs 21% (23/110), P = 0.50 and TV, 6% (1/18) vs 18% (9/49), P = 0.69).Conclusions: Despite the implementation of an EPT protocol, STI reinfection rates among female AYA remained high, and many declined EPT. Further research is needed to identify barriers to the provision and acceptance of EPT and ways to address these factors.

Reducing Barriers for Expedited Partner Treatment in Adolescents and Young Adults: A Quality Improvement Initiative

“…Although not the primary outcome, we hoped that improved counseling and increased EPT access would lead to increased rates of retesting. Our retesting rate of 35% to 60% across AMC and the ED is similar to findings from other studies 19–21 …”

“…Our retesting rate of 35% to 60% across AMC and the ED is similar to findings from other studies. [19][20][21] Reinfection rates did drop significantly for the AMC in our study, which was the site with the most patients. Numbers of retested patients in AMC and the ED were too small to analyze by EPT.…”

“…A 2021 study conducted at an Ohio AMC found that only 25% to 28% of patients who were offered EPT accepted a written prescription. 20 In contrast, a study focusing on adolescents in a school-based health center in New York City, where patients were provided medications directly for their partner, reported a higher acceptance at 65%. 24 This difference in acceptance rates might be influenced by factors such as the convenience of receiving medications directly (patient-delivered partner treatment, or PDPT) versus obtaining a prescription for their partner, which could significantly impact uptake.…”

“…Rates in the literature vary considerably. A 2021 study conducted at an Ohio AMC found that only 25% to 28% of patients who were offered EPT accepted a written prescription 20 . In contrast, a study focusing on adolescents in a school-based health center in New York City, where patients were provided medications directly for their partner, reported a higher acceptance at 65% 24 .…”

“…6 However, findings in the literature are not consistent. Gannon-Loew et al 20 found higher EPT offer rates among Black individuals, whereas Mickiewicz et al 19 reported that Black patients were less likely to accept EPT compared with White patients. These conflicting results suggest that the relationship between race and EPT offering, provision, and acceptance is complex and may vary across different populations and settings.…”