Patient-delivered partner therapy for sexually transmitted diseases as practiced by U.S. physicians.
ABSTRACT The objective of this study was to estimate how many U.S. physicians practice patient-delivered partner therapy (PDPT), which is the practice of giving patients diagnosed with curable sexually transmitted infections medication to give to their sex partners.
The authors conducted a national survey of physicians in specialties that diagnose the majority of sexually transmitted diseases in the United States.
A total of 3011 physicians diagnosed at least 1 case of either gonorrhea or chlamydial infection in the preceding year. For gonorrhea and chlamydial infection, 50% to 56% reported ever using PDPT; 11% to 14% reported usually or always doing so. Obstetricians and gynecologists and family practice physicians more often used PDPT than internists, pediatricians, and emergency department physicians. Clinicians who collected sex partner information, as well as those who saw more female and white patients, used PDPT most often.
PDPT is widely but inconsistently used throughout the United States and is typically provided to a minority of persons.
Sex Transm Dis 11/2014; 41(11):695-697. DOI:10.1097/OLQ.0000000000000207 · 2.75 Impact Factor
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ABSTRACT: Expedited partner therapy (EPT), the practice of treating the sex partners of persons with sexually transmitted infections without their medical evaluation, increases partner treatment and decreases gonorrhea and chlamydia reinfection rates. We conducted a stepped-wedge, community-level randomized trial to determine whether a public health intervention promoting EPT could increase its use and decrease chlamydia test positivity and gonorrhea incidence in women. The trial randomly assigned local health jurisdictions (LHJs) in Washington State, US, into four study waves. Waves instituted the intervention in randomly assigned order at intervals of 6-8 mo. Of the state's 25 LHJs, 24 were eligible and 23 participated. Heterosexual individuals with gonorrhea or chlamydial infection were eligible for the intervention. The study made free patient-delivered partner therapy (PDPT) available to clinicians, and provided public health partner services based on clinician referral. The main study outcomes were chlamydia test positivity among women ages 14-25 y in 219 sentinel clinics, and incidence of reported gonorrhea in women, both measured at the community level. Receipt of PDPT from clinicians was evaluated among randomly selected patients. 23 and 22 LHJs provided data on gonorrhea and chlamydia outcomes, respectively. The intervention increased the percentage of persons receiving PDPT from clinicians (from 18% to 34%, p < 0.001) and the percentage receiving partner services (from 25% to 45%, p < 0.001). Chlamydia test positivity and gonorrhea incidence in women decreased over the study period, from 8.2% to 6.5% and from 59.6 to 26.4 per 100,000, respectively. After adjusting for temporal trends, the intervention was associated with an approximately 10% reduction in both chlamydia positivity and gonorrhea incidence, though the confidence bounds on these outcomes both crossed one (chlamydia positivity prevalence ratio = 0.89, 95% CI 0.77-1.04, p = 0.15; gonorrhea incidence rate ratio = 0.91, 95% CI .71-1.16, p = 0.45). Study findings were potentially limited by inadequate statistical power, by the institution of some aspects of the study intervention outside of the research randomization sequence, and by the fact that LHJs did not constitute truly isolated sexual networks. A public health intervention promoting the use of free PDPT substantially increased its use and may have resulted in decreased chlamydial and gonococcal infections at the population level. ClinicalTrials.gov NCT01665690.PLoS Medicine 01/2015; 12(1):e1001777. DOI:10.1371/journal.pmed.1001777 · 14.00 Impact Factor