Guidance on the Use of Expedited Partner Therapy in the Treatment of Gonorrhea

Expedited Partner Therapy (EPT) is a partner treatment approach where sex partners of patients who test positive for certain sexually transmitted diseases are provided treatment without previous medical evaluation. Because of EPT’s effectiveness in reducing gonorrhea reinfection rates⁵ , CDC has recommended its use since 2006 for the heterosexual partners of patients diagnosed with gonorrhea if it was unlikely the partners would seek timely evaluation and treatment.²

However, as of 2012, CDC no longer recommends the routine use of orally-administered cefixime for the treatment of gonorrhea in the United States.³ At present, the only CDC-recommended treatment of uncomplicated urogenital, anorectal, and pharyngeal gonorrhea is combination therapy with a single intramuscular dose of ceftriaxone 250 mg plus a single dose of azithromycin 1 g orally.

Since EPT is not possible where treatment involves an injection, the current CDC gonorrhea treatment recommendations have implications for the use of EPT in the treatment of gonorrhea. CDC continues to recommend EPT for heterosexual men and women with gonorrhea for whom health department partner-management strategies are impractical or unavailable and whose providers are concerned about partners’ access to prompt clinical evaluation and treatment. This document is intended to provide guidance to providers who choose to use EPT for gonorrhea, and to answer frequently asked questions.
 

1. In light of CDC’s recent changes to its gonorrhea treatment recommendations, can EPT be used for gonorrhea?

• Under current guidelines every effort should be made to ensure that a patient’s sex partners from the past 60 days are evaluated and treated with the recommended regimen (ceftriaxone 250 mg IM plus a single dose of azithromycin 1 g orally). However, because that is not always possible, providers should still consider EPT for heterosexual partners of patients diagnosed with gonorrhea who are unlikely to access timely evaluation and treatment. EPT is not routinely recommended for MSM because of a high risk for coexisting infections, especially undiagnosed HIV infection, in their partners.

2. Since CDC no longer recommends exclusively oral treatment for gonorrhea, how does CDC recommend EPT be practiced for gonorrhea?

• If a provider considers it unlikely that a heterosexual partner of a gonorrhea patient will access timely evaluation and treatment, EPT with cefixime and azithromycin should still be considered, as not treating partners is significantly more harmful than is the use of EPT for gonorrhea. As has always been the case, medication or prescriptions provided as part of EPT should be accompanied by treatment instructions, appropriate warnings about taking medications (if the partner is pregnant or has an allergy to the medication), general gonorrhea health education and counseling, and a statement advising that partners seek personal medical evaluation, particularly women with symptoms of PID.⁴

1. Kissinger P, Mohammed H, Richardson-Alston G, et al. Patient-delivered partner treatment for male urethritis: a randomized, controlled trial. Clin Infect Dis 2005;41:623–9.

2. Centers for Disease Control & Prevention (CDC). 2015 Sexually Transmitted Diseases Treatment Guidelines. Atlanta: U.S. Department of Health and Human Services; 2015. Accessible at: https://www.cdc.gov/std/tg2015/clinical.htm . Accessed Aug. 19, 2015.

3. Centers for Disease Control & Prevention (CDC). Update to CDC’s sexually transmitted diseases treatment Guidelines, 2010: Oral cephalosporins no longer a recommended treatment for gonococcal infections. MMWR 2012;61:590-4.

4. Expedited Partner Therapy. August 9, 2012. Available at: https://www.cdc.gov/std/ept/default.htm. Accessed Aug. 6, 2013

5. Golden MR, Whittington WL, Handsfield HH, Hughes JP, Stamm WE, Hogben M, Clark A, Malinski C, Helmers JR, Thomas KK, Holmes KK. Effect of expedited treatment of sex partners on recurrent or persistent gonorrhea or chlamydial infection. N Engl J Med. 2005 Feb 17;352(7):676-85.