Dear Colleague Letter
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December 1, 2008
The Minnesota Department of Health (MDH) is pleased to announce a new strategy to help reduce Sexually Transmitted Disease (STD)-related morbidity in Minnesota. Expedited partner therapy (EPT) is the practice of treating sex partners of persons with STDs without an intervening clinical exam. The implementation of EPT involves a clinician dispensing medication, or a prescription for medication, directly to their patient to be delivered to his/her sexual partner(s). In May 2008, Minnesota pharmacy statutes were amended removing the only known legal barrier to implementing EPT in Minnesota.
As you may know, Minnesota’s STD burden has increased substantially over the past decade: chlamydia incidence has doubled while the gonorrhea rate increased by 37%. Chlamydia and gonorrhea remain the first and second most commonly reported communicable diseases in the state, respectively. Furthermore, 10-12 per cent of people reported to the MDH with chlamydia or gonorrhea have “repeat” infections, meaning they had at least one other infection reported in the previous year. Many of these cases likely were the result of re-infection by untreated partners. Re-infection of cases and untreated infections in partners can lead to complications such as pelvic inflammatory disease and infertility and further spread of disease.
Prompt treatment of sexual partners is a core component of STD control. Ideally, partners would present themselves for evaluation and treatment shortly after being notified of their exposure. However, many partners are unable or unwilling to seek clinical services. In these situations, EPT should be implemented if the medical provider determines that it is the only reasonable way to access and treat partners of chlamydia and gonorrhea infected persons in order to prevent re-infection and control spread of disease. Still, the best way to treat STDs is for partners to receive testing, treatment and counseling from a medical provider.
EPT has been recommended by the U.S Centers for Disease Control and Prevention (CDC) and the American Medical Association (AMA) as an effective partner management strategy for patients with chlamydia or gonorrhea. Medical providers in a number of states including California, New Mexico and Texas have used EPT with great success.
In response to the new EPT legislation, the MDH has developed guidance for the implementation of EPT for chlamydia and gonorrhea by medical providers in Minnesota. The guidance is now available on our website. The MDH is also hosting an EPT symposium on January 13, 2009 for medical providers. We hope that you will be able to join us.
We look forward to working with you on EPT implementation and encourage you to contact MDH at (651) 201-5414 with any questions about this new strategy to decrease STDs.
Ruth Lynfield, M.D.
Peter Carr, MPH, Section Manager
STD and HIV Section
Infectious Disease Epidemiology, Prevention and Control Division
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