One way to lower STI rates in Pennsylvania: expedited partner therapy

It is difficult to be the bearer of bad news, which is why calling my patients to inform them that they have a sexually transmitted infection (STI) is not one of the tasks I look forward to as a physician.

Luckily, along with providing information about the infection, I am also able to prescribe what is usually a quick treatment and cure in the form of antibiotics. But without also treating a patient’s sexual partners, there is potential for reinfection. A small change in Pennsylvania law can prevent that risk.

Expedited partner therapy (EPT) allows health-care providers to treat the sex partners of a patient who has tested positive for an STI without needing to see the partners directly for an exam or test. As an OB-GYN, EPT allows me to prescribe antibiotics to the partners of my patients who have tested positive for gonorrhea, chlamydia, or trichomonas. While EPT is currently permissible in Pennsylvania, the lack of explicit legislation around EPT causes confusion and prevents many providers from offering this treatment.

If passed, Senate Bill 317, the Expedited Partner Therapy Act, would legalize the provision of expedited partner therapy in the commonwealth, reducing STI infection rates and improving the health of Pennsylvanians.

In 2019 alone, Pennsylvania reported over 61,000 cases of chlamydia and 16,000 cases of gonorrhea, and these rates have been increasing in recent years. EPT has well-documented benefits, most importantly decreasing reinfection rates when compared with the standard practice of asking patients to refer their partners to be seen by a provider.

EPT has been recommended by several large medical organizations, including the American Congress for Obstetrics and Gynecology, the American Osteopathic Association, the American Academy of Family Physicians, and the Centers for Disease Control and Prevention. Currently, EPT is permissible in 46 states, but there are nuances in the law that can make EPT more or less accessible to patients.

In Pennsylvania, a provider can write a prescription for a patient’s partner; however, the prescription must show the full name and address of the intended patient. This often means that after being informed of their results, my patients are asked to talk to their partners. If their partners would like treatment, they need to call the clinic with their partners’ information so that the prescription can be written. This step can be a hurdle for many patients, and as a result, many partners go untreated.

Those with concerns about EPT focus on the potential risks of prescribing antibiotics for a patient who has not been evaluated. Of course, all medications have risks, and it is important to convey these to the patient when providing a partner prescription. However, these risks are small in comparison to the potential long-term damage done by an untreated STI, including pelvic inflammatory disease, pain, and infertility.

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States that explicitly make EPT permissible protect health-care providers and pharmacists from liability, and streamline the prescription process. SB 317 would allow providers to offer EPT by writing a prescription that includes the words “expedited partner therapy” or “EPT,” bypassing the need for names and personal information.

Individuals who have tested positive for an STI could then give the prescription directly to their sexual partners without the middleman. Prescribers would be responsible for providing the patients with information on the antibiotic, including how to take it appropriately, possible side effects or adverse reactions, and conditions that would prevent their partner from being able to safely take the medication. The bill unanimously passed the Pennsylvania Senate in April, and a vote is expected in the House within the next few weeks.

This year, tens of thousands of Pennsylvanians will be informed that they have tested positive for a sexually transmitted infection. With the assistance of SB 317, those individuals and their partners would be able to quickly access treatment, reducing the spread of infections. At a time when we should be focused on creating smart, effective public health policy, SB 317 should be an easy decision for our lawmakers.

Sarah Gutman is an OB-GYN specializing in complex family planning and a Leonard Davis Institute of Health Economics fellow. She lives and works in Philadelphia.