Patient-Delivered Partner Therapy for Sexually Transmitted Diseases as Practiced by U.S. Physicians
Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. Sex Transm Dis
(Impact Factor: 2.84).
03/2005; 32(2):101-5. DOI: 10.1097/01.olq.0000151417.43230.18
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.
Available from: Corey S. Davis
- "States and medical societies have long recognized that while this rule generally furthers patient health and safety, in some cases it can impede access to necessary medications. Perhaps the most well-known example of this recognition is expedited partner therapy (EPT), in which medications to treat sexually transmitted infections (STI) such as chlamydia and gonorrhea are prescribed to one individual with the explicit knowledge they will also be administered to that person's sex partner or partners (Hogben et al., 2005). In such cases, treating only the patient the prescriber sees is likely insufficient, as the chance of reinfection is high unless the infected partner is treated as well (American College of Obstetricians and Gynecologists, 2015). "
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Opioid overdose, which has reached epidemic levels in the United States, is reversible by administration of the medication naloxone. Naloxone requires a prescription but is not a controlled substance and has no abuse potential. In the last half-decade, the majority of states have modified their laws to increase layperson access to the medication.
We utilized a structured legal research protocol to systematically identify and review all statutes and regulations related to layperson naloxone access in the United States that had been adopted as of September, 2015. Each law discovered via this process was reviewed and coded by two trained legal researchers.
As of September, 2015, 43 states and the District of Columbia have passed laws intended to increase layperson naloxone access. We categorized these laws into three domains: (1) laws intended to increase naloxone prescribing and distribution, (2) laws intended to increase pharmacy naloxone access, and (3) laws intended to encourage overdose witnesses to summon emergency responders. These laws vary greatly across states in such characteristics as the types of individuals who can receive a prescription for naloxone, whether laypeople can dispense the medication, and immunity provided to those who prescribe, dispense and administer naloxone or report an overdose emergency.
Most states have now passed laws intended to increase layperson access to naloxone. While these laws will likely reduce overdose morbidity and mortality, the cost of naloxone and its prescription status remain barriers to more widespread access.
Available from: sfcityclinic.org
- "We note that although testing was compensated , treatment was not. The second is the limited availability of field-delivered therapy protocols and PDPT protocols in other counties and states  . Third, the baseline prevalence of infection in our sample was modest and the prospective cohort relatively small such that without a comparison group, the true effectiveness of the field interventions , including PDPT, could not be compared with other models of STD screening and management in a similar population. "
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ABSTRACT: Current Centers for Disease Control (CDC) guidelines recommend that sexually transmitted disease (STD) screening measures for high-risk populations such as homeless youth prioritize testing in out-of-clinic settings and incorporate new approaches to STD eradication, such as field-delivered testing and treatment and patient-delivered partner therapy (PDPT). Our non-medically trained research staff offered field-based STI testing, field-delivered therapy, and PDPT to homeless youth in the context of a longitudinal study.
A total of 218 ethnically diverse (34% female) 15-24-year-old homeless youth recruited from street sites in San Francisco completed an audio computer-administered self-interview survey and provided a first-void urine sample for testing for chlamydia (CT) and gonorrhea (GC). Youth testing positive were offered field-delivered therapy and PDPT. A random subset of 157 youth was followed prospectively, of whom 110 (70%) were interviewed and 87 (55%) retested at six months.
At baseline, 99% of youth in the study consented to STI testing, of whom 6.9% and .9% tested positive for CT and GC, respectively. Ninety-four percent of positive youth were treated, 50% within one week. The incidence rate for CT was 6.3 per 100 person-years (95% confidence interval [CI]: 1.3-18.4) and for GC was 4.2 per 100 person-years (95% CI: .5-15.2). None of the youth treated by study staff and tested six months later (n = 6) had CT or GC on follow-up testing (95% CI: 0-131.3).
Field-delivered testing and field-delivered therapy are feasible, acceptable and effective interventions for the diagnosis and treatment of STDs in homeless youth. These measures along with PDPT may decrease rates of subsequent reinfection.
Available from: cid.oxfordjournals.org
- "The efficacy of PDPT has been examined in both retrospective studies[6,7]and randomized , controlled trials8910and has shown that partners are more likely to get treated and that index patients are less likely to be reinfected after PDPT, compared with partner referral . PDPT is gaining more acceptance, and although it is not yet explicitly legal in many states, it is widely—albeit sporad- ically—practiced[2,11,12]. PDPT has not been well studied in high-risk heterosexual minority men who present with urethritis . "
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ABSTRACT: Traditional partner referral for sexually transmitted diseases (STDs) is ineffective at assuring that partners are treated. Alternative methods are needed. We sought to determine whether patient-delivered partner treatment (PDPT) is better than 2 different methods of partner referral in providing antibiotic treatment to sex partners of men with urethritis and in reducing recurrence of Chlamydia trachomatis and Neisseria gonorrhoeae.
Men who received a diagnosis of urethritis at a public STD clinic in New Orleans, Louisiana, during the period of December 2001 through March 2004 were randomly assigned according to the month of treatment for either standard partner referral (PR), booklet-enhanced partner referral (BEPR), or PDPT. At baseline and after 1 month, men were asked to provide information about each partner and were tested for C. trachomatis and N. gonorrhoeae.
Most enrolled index men (n = 977) were > 24 years of age (51.6%) and African American (95%) and had > or = 2 partners (68.3%). They reported information on 1991 partners, and 78.8% were reinterviewed 4-8 weeks later. Men in the PDPT arm were more likely than men in the BEPR and PR arms to report having seen their partners, having talked to their partners about the infection, having given the intervention to their partners, and having been told by their partners that the antibiotic treatment had been taken (55.8%, 45.6%, and 35.0%, respectively; P < .001). Of men who were reinterviewed, 37.5% agreed to follow-up testing for N. gonorrhoeae and C. trachomatis infection. Those tested were similar to those not tested with regard to the study variables measured. Among those tested, men in the PDPT and BEPR arms were less likely than those in the PR arm to test positive for C. trachomatis and/or N. gonorrhoeae (23.0%, 14.3%, and 42.7%, respectively; P < .001).
Among heterosexual men with urethritis, PDPT was better than standard partner referral for treatment of partners and prevention of recurrence of C. trachomatis or N. gonorrhoeae infection.
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