Reply: Regarding “Effectiveness of Chlamydia trachomatis expedited partner therapy in pregnancy”

Abstract

We appreciate the interest in our recent report on the realworld effectiveness of Chlamydia trachomatis expedited partner therapy (EPT) in pregnancy. 1 As has been well described, there are potential barriers at all levels of implementation of EPT, including concerns about partner adverse events, physician liability and malpractice, payment for medications, intimate partner violence, and the fact that most community pharmacists were unaware of EPT per a recent assessment. 2 Golden et al 3 also acknowledged that EPT was less effective in reducing persistent or recurrent chlamydia compared with gonorrhea in their 2005 randomized trial of men and nonpregnant women.Indeed, although we agree that EPT is 1 of many strategies needed to address the rising rates of sexually transmitted infections in the United States, 4 we felt that an evaluation of our EPT program-which included a direct method for treating partners with azithromycin tablets instead of a prescription-was necessary in real-world practice. We reported our outcomes and acknowledged both the limitations of our observational study and the strengths of our standardized practices in a high-risk, urban population. Without this assessment, we would have no baseline for comparison with future efforts. We suspect that the practice of providing EPT for chlamydial infection in a real-world prenatal setting is more likely to resemble our own, rather than that of a clinical trial, and we hope that the general obstetrician-gynecologists find our report informative and motivating. As we described, additional solutions, including but not limited to EPT, are needed to make progress in reducing the surge in sexually transmitted infections in the United States.

Phototherapy-Based Treatment for Sexually Transmitted Infections—Shining Light into Unexplored Territory

“…For infectious diseases caused by C. trachomatis, the first-line treatment is doxycycline in the European and American guidelines [34]. However, in the event of an allergy to doxycycline or in pregnant women, a single dose of oral azithromycin or erythromycin (500 mg) has been used [35]. Exceptional treatment failure has been reported with this treatment, which could then be controlled with moxifloxacin.…”