A National Study of Expedited Partner Therapy Use in Emergency Departments: A Survey of Medical Director Knowledge, Attitudes, and Practices.

BACKGROUND: Emergency departments (EDs) are the primary source of health care for many patients diagnosed with sexually transmitted infections (STIs). Expedited partner therapy (EPT), treating the partner of patients with STIs, is an evidence-based practice for patients who might not otherwise seek care. Little is known about the use of EPT in the ED. In a national survey, we describe ED medical directors' knowledge, attitudes, and practices of EPT. METHODS: A cross-sectional survey of medical directors from academic EDs was conducted from July to September 2020 using the Academy of Academic Administrators of Emergency Medicine Benchmarking Group. Primary outcomes were EPT awareness, support, and use. The survey also examined barriers and facilitators. RESULTS: Forty-eight of 70 medical directors (69%) responded. Seventy-three percent were aware of EPT, but fewer knew how to prescribe it (38%), and only 19% of EDs had implemented EPT. Seventy-nine percent supported EPT and were more likely to if they were aware of EPT (89% vs. 54%; P = 0.01). Of nonimplementers, 41% thought EPT was feasible, and 56% thought departmental support would be likely. Emergency department directors were most concerned about legal liability, but a large proportion (44%) viewed preventing sequelae of untreated STIs as "extremely important." CONCLUSIONS: Emergency department medical directors expressed strong support for EPT and reasonable levels of feasibility for implementation but low utilization. Our findings highlight the need to identify mechanisms for EPT implementation in EDs.

Youth Knowledge and Perspectives on Expedited Partner Therapy.

PURPOSE: Expedited partner therapy (EPT) is an effective sexually transmitted infection (STI) treatment and prevention practice that allows clinicians to provide treatment to the sexual partner(s) of individuals diagnosed with chlamydia and/or gonorrhea infections without a clinical evaluation. Due to the high incidence of STIs among youth, we sought to understand youth awareness and beliefs about EPT use. METHODS: MyVoice, a national text message survey of youth aged 14-24 years, posed 5 questions on EPT knowledge and perceptions to 1,115 youth in August 2018. Responses were reviewed to identify themes and iteratively develop a codebook. Two reviewers independently coded each question, and a third reviewer resolved discrepancies. Summary statistics were calculated for demographic and thematic analysis. RESULTS: A total of 835 participants responded to at least 1 question (74.9% response rate). Majority of youth (91.9%, n = 730/794) felt that it would be important to help their partners get treatment if they tested positive for chlamydia or gonorrhea. Although most participants were unaware of EPT (86.4%, n = 657/760), 81.3% (n = 624/768) supported the policy stating that it is "pretty darn convenient." Youth also noted they would be interested in asking their provider for EPT. Participants opposing EPT (6.9%, n = 53/768) noted that "they [sexual partner] are responsible for their own health" and preferred to "tell my partner to go to [their] doctor." CONCLUSIONS: Most youth in the MyVoice cohort felt that EPT was a good way to get treatment for their partners, even though the majority were not aware that EPT was available as an STI treatment option.

The future of STI screening and treatment for youth: a National Survey of youth perspectives and intentions.

BACKGROUND: Sexually transmitted infection (STI) rates continue to rise in the U.S., with disproportionately high rates among those aged 15-24 years. Effective programs and policies are necessary to address this growing public health problem. The purpose of this study is to assess the perspectives of a national sample of youth on access to STI care and behaviors regarding STIs. METHODS: MyVoice, a national text message survey of youth, was used to pose four open-ended questions on STI screening and treatment to 1115 youth aged 14-24 in August 2018. A mixed-methods strategy was employed for the study. Qualitative data was analyzed using a modified grounded theory approach. Summary statistics were calculated for demographic data and prevalence of themes. RESULTS: Of the 800 participants who responded to at least one question (72% response rate), mean age was 19 years (SD = 3.1), 55% identified as female, 61% identified as non-Hispanic white, and 33% qualified for free/reduced lunch. A majority felt it would be easy to get screened (69%) or treated (68%) for an STI. Nearly all respondents (95%) stated they would share an STI diagnosis with their sexual partners. CONCLUSIONS: Despite high rates of STIs among youth, most respondents reported that STI screening and treatment is accessible, and they would share an STI diagnosis with their partner.

Association between Chlamydia and routine place for healthcare in the United States: NHANES 1999-2016.

BACKGROUND: The United States is experiencing a surge in Chlamydia trachomatis (CT) infections representing a critical need to improve sexually transmitted infection (STI) screening and treatment programs. To understand where patients with STIs seek healthcare, we evaluated the relationship between CT infections and the place where individuals report usually receiving healthcare. METHODS: Our study used a nationally representative sample from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2016. The study population is adult patients, aged 18 to 39 years in whom a urine CT screen was obtained. Logistic regression models were used to determine if location of usual healthcare was predictive of a positive urine CT screen result. Models were adjusted for known confounders including age, gender, race/ethnicity, education, and insurance status. RESULTS: In this nationally representative sample (n = 19,275; weighted n = 85.8 million), 1.9% of individuals had a positive urine CT result. Participants reported usually going to the doctor's office (70.3%), "no place" (24.8%), Emergency Department (ED) (3.3%), or "other" place (1.7%) for healthcare. In adjusted models, the predicted probability of having a positive urine CT result is higher (4.9% vs 3.2%, p = 0.022; OR = 1.58) among those that reported the ED as their usual place for healthcare compared to those that reported going to a doctor's office or clinic. CONCLUSIONS: Individuals having a positive urine CT screen are associated with using the ED as a usual source for healthcare. Understanding this association has the potential to improve STI clinical and policy interventions as the ED may be a critical site in combatting the record high rates of STIs.

Availability of Sexually Transmitted Infection Screening and Expedited Partner Therapy at Federally Qualified Health Centers in Michigan.

Via secret shopper study, we assessed: (1) availability of sexually transmitted infection (STI) screening; (2) provision of expedited partner therapy; and (3) wait times for new patient STI screening appointments at Michigan federally qualified health centers. Of the 147 clinics with STI screening availability, 10.2% (15) confirmed expedited partner therapy provision.

Improving Women's Health and Combatting Sexually Transmitted Infections Through Expedited Partner Therapy.

Sexually transmitted infections (STI), including Chlamydia trachomatis and Neisseria gonorrhoeae, have reached record high rates in the United States. Sexually transmitted infections disproportionately affect reproductive-aged females aged 15-44 years, who account for 65% and 42% of the total reported C trachomatis and N gonorrhoeae cases, respectively. Undiagnosed STIs can result in serious health complications that put women at an increased risk for pelvic inflammatory disease, ectopic pregnancy, and tubal factor infertility. Many of these women are seen by physicians (eg, obstetrician-gynecologists, family medicine doctors, pediatricians) or other clinicians (eg, nurse practitioners, midwives, physician assistants) who care for women. These clinicians have the opportunity to help curb the continued increase in STI incidence rates with the implementation and use of expedited partner therapy. Expedited partner therapy is a proven effective health care practice that allows clinicians to give patients medications or prescriptions to distribute to their partners. Despite expedited partner therapy's proven effectiveness, there are barriers to its implementation that must be understood to enhance STI treatment and prevention efforts. In this commentary, we discuss these barriers, and appeal to women's health clinicians to implement or increase use of expedited partner therapy for the treatment of women with STIs and their sexual partners.