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New Mexico Department of Health Guidelines for
Expedited Partner Treatment (EPT) of Sexually
Transmitted Diseases (STDs)

On Jan. 10th, 2007 the New Mexico Practice Act was amended to allow for
Expedited Partner Treatment for sexually transmitted diseases.
Background:

Expedited Partner Treatment (EPT) is a mechanism for providers to treat patients with whom
they have not established a therapeutic relationship, in order to prevent re-infection of an
index patient. Heterosexual patients with uncomplicated gonorrhea or chlamydia have lower
rates of re-infection when their sexual partners are provided with EPT, according to published
research supported by the Centers for Disease Control and Prevention (CDC).
A “Dear Colleague” letter dated May 11, 2005 from Dr. John M. Douglas Jr., Director of the
CDC Division of STD Prevention, stated that the “CDC has concluded that EPT is a useful
option to facilitate partner management, particularly for treatment of male partners of women
with chlamydial infection or gonorrhea.” Dr. Douglas’s letter urged state health departments
to work toward removing legal and administrative barriers that prevent use of EPT.
A complete review of the studies and recommendations were published in 2006 by the CDC
in “Expedited Partner Therapy in the Management of Sexually Transmitted Diseases: Review
and Guidance.” The report is available online:
http://www.cdc.gov/std/treatment/EPTFinalReport2006.pdf.
The New Mexico Medical Board amended the Medical Practice Act to allow health
professionals to offer EPT to partners of patients with STDs under guidelines
developed by the New Mexico Department of Health (NMDOH). The guidelines follow
:
Expedited Partner Treatment Guidelines:

These guidelines are to assist clinicians in deciding when to offer EPT and outline procedures
to follow when choosing this option.
Kristine Suozzi, Division Director Public Health Division
1190 St. Francis Dr., Suite 1050 • P.O. Box 26110 • Santa Fe, New Mexico • 87502 (505) 827-2389 • FAX: (505) 827-2329 • http://www.nmhealth.org
General Principles
:
The best approach is for the partner(s) of a patient diagnosed with any STD to be
evaluated, examined, tested, counseled, and treated by a medical provider. The index
patient who is diagnosed with an STD should be counseled to have their sexual partner(s)
evaluated by their own primary care provider or at a public health clinic, and not to resume
sexual intercourse with that partner until the partner has been adequately treated. Ideally,
a written referral is provided to every patient with an STD that states the diagnosis, the
treatment provided, and where the partner may obtain medical care. (Referral forms are
available from the NMDOH STD Program).
Patients diagnosed with gonorrhea, chlamydia, or trichomoniasis should be encouraged to
notify all of the people with whom they have had sexual contact within the past two
months. The partner(s) should be told the specific infection that they have been exposed
to and offered a written referral. The patient may be offered EPT if the patient believes
that their partner(s) will refuse to seek care or will not be able to obtain medical care.
Medication for EPT should be provided for all sexual partners within two months prior to
diagnosis or onset of symptoms. If there were no partners in the past two months, then
the most recent sexual partner should be treated. Medications should not be provided
to treat other sexual partners of partners to the index case.
Additional partners of a
partner who is given EPT should be encouraged to seek medical evaluation, especially if
they are experiencing symptoms of an STD.
EPT for Female Partners:

The most appropriate patients for EPT are the male partners of women with a
laboratory-confirmed diagnosis of gonorrhea, chlamydia, or trichomoniasis.

Clinicians do have the option of providing EPT for female partners of patients with
gonorrhea, chlamydia, or trichomoniasis infections. Heterosexual male patients with
gonorrhea or chlamydia should be informed that it would be best for their female partners
to have a medical evaluation, but if they feel that their partner is unwilling or unable to
seek care, then EPT may be provided unless the partner is known to be pregnant.
Medications should not generally be provided to pregnant partners. Refer pregnant
women to their prenatal care provider or to another medical provider.

Men Who Have Sex With Men:
There are no studies demonstrating the effectiveness of EPT for men who have sex with men (MSM). MSM who are contacts to gonorrhea or chlamydia should be examined and tested for other STDs, such as syphilis and HIV, and therefore male partners of MSM should be encouraged to seek medical evaluation whenever possible.
Making Contact With Partners and Documentation:

A note in the index patient’s medical chart should document the number of partners who
are being provided with EPT, the medication and dosage being provided, and whether the
partner is known to be allergic to any medications. It is recommended that the names of
partners receiving EPT not be written in the index patient’s chart. Sexual partners do not
require a medical chart in order to be provided with EPT.
Whenever possible, telephone contact should be made with the sexual partner(s) to
explain the reason for providing EPT, to ask about allergies to medications, medical
problems, medications being taken, to ask about other symptoms of STDs (such as
whether there are sores, ulcers, discharge, testicular, or abdominal pains that need
medical evaluation), and to answer questions. Female partners for EPT should be asked
if they are pregnant or breastfeeding, and if they have any symptoms such as abdominal
pain that will require immediate medical evaluation. Partners should be advised to abstain
from intercourse for seven days after taking the medication.
Gonorrhea and Chlamydia are reportable diseases. Clinicians are required to report
infections to the NMDOH. Reporting forms are available on the NMDOH website
(http://www.health.state.nm.us/std.html). The index patient and their named partners may
be contacted for purposes of contact tracing by NMDOH staff. Contact the NMDOH
Regional Office or the STD Program for further information.

Medication may be provided in the following ways:
(The New Mexico Board of Pharmacy adopted language to permit EPT
under NMDOH Guidelines on Oct. 29, 2007.)

1. Medication may be provided to the index patient to take to his or her partner(s.) 2. Separate prescriptions may be written for the index patient and his or her partner(s). 3. If the index patient will not, or is not able to, identify the partner(s) by name, the provider may write a prescription for an “unnamed partner.” Recommended Treatments:
For chlamydial infection

Partners of patients with chlamydial infection should be treated with azithromycin 1-gram
PO unless the partner is allergic to macrolide antibiotics. In this situation, consult the STD
Treatment Guidelines, 2006 (see below) or contact a consulting physician for further
instructions.

For gonorrhea

Partners of patients with uncomplicated gonorrhea should be treated with cefpodoxime (Vantin) 400mg or cefuroxime (Ceftin) 1 gram PO. Please Note: Quinolone antibiotics (i.e. ciprofloxacin, levofloxacin, ofloxacin) are no
longer recommended for the treatment of gonorrhea in the United States, as
reported in the MMWR, April 13, 2007.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5614a3.htm?s_cid=mm5614a3_e
High rates of ciprofloxacin resistant gonorrhea have recently been found in New
Mexico. Suspected pharyngeal gonorrhea should not be treated with oral
cephalosporin antibiotics. Consult the Current Updated Recommended Treatment
Regimens for Gonorrhea Infections and Associated Conditions – US, 2007.
physician for alternative treatments.
Partners of patients with gonorrhea should be co-treated for chlamydia unless the
index case has a negative chlamydia test result using a nucleic acid amplification test
(NAAT) technology such as a PCR, LCR, or TMA. All chlamydia tests performed on
urine specimens are NAATs. Use azithromycin 1-gram PO to co-treat for chlamydia. It
is not recommended that patients with chlamydia be co-treated for gonorrhea.

Trichomoniasis:

The CDC does not recommend routine use of EPT in the management of male partners of
women with trichomoniasis because their male partners are at high risk of having other
STDs (especially gonorrhea and chlamydia). When possible, it is best for male partners of
women with trichomoniasis to undergo a complete STD evaluation. When using EPT for
trichomoniasis, use metronidazole (Flagyl) 2-grams orally in a single dose.
Please note: Partners should be informed not to take metronidazole if they have
consumed alcohol in the previous 12 hours, and to abstain from all alcohol for 24
hours following treatment.
Other STDs:
These guidelines are only for treatment of gonorrhea, chlamydia, and trichomoniasis.
There is limited evidence to support this intervention with any other STDs at this time.
For further information on treatment of STDs refer to: STD Treatment Guidelines, 2006
Centers for Disease Control and Prevention (CDC) MMWR 2006; 55 (No. RR-11).
Available online: http://www.cdc.gov/std/treatment/
Written Information For Partners:
Every patient should be provided with a NMDOH medication sheet (available in English and Spanish) for each partner who will receive EPT. The medication sheet includes information that encourages partners to be clinically evaluated after receiving their EPT, informs them of symptoms that need immediate evaluation, warns not to take the medication if allergic, discusses common side-effects, and provides telephone numbers to call for information. The index patient should be counseled to tell their partner(s) that it is important to read the information contained in the medication sheet before taking the medication. . Re-testing and Tests-of-Cure:

Tests-of-cure are not routinely recommended for non-pregnant patients who are
treated for gonorrhea, chlamydia, or trichomoniasis, nor are they recommended for
the sexual partners who receive EPT. However, because of high rates of re-infection,
especially in women, the CDC recommends that all women with gonorrhea or
chlamydia be re-tested 3 months after treatment. If the patient is not re-tested in 3
months, providers are encouraged to test whenever the patient next seeks medical
care within the following 3-12 months, regardless of whether the patient believes that
her sex partners were treated.

Consultations:

a. Bruce Trigg, MD Medical Director, NM Department of Health STD Program, Regions 1and 3 Office: 505-841-4112 or cell phone: 505-239-9074 b. Steve Jenison, MD Medical Director for Infectious Diseases, New Mexico Department of Health Office: 505-476-3668 or Answering Service: 505-260-7922. c. Elaine Thomas, MD Professor of Infectious Diseases, University of New Mexico Health Sciences Center PALS Line: 505-272-2000 d. Regional Health Officers or other designated clinicians in each Department Reporting Adverse Events:
Report any adverse events that result from EPT to the NM Department of Health STD Program: 505-476-3611. .

Source: http://www.nmhealth.org/pdf/EPT%20Guidelinesfinal.pdf

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