Arizona Department of Health Services– Public Health Services
150 N. 18th Avenue Phoenix, Arizona 85007 USA http://www.azdhs.gov

January 2009

EXPEDITED PARTNER THERAPY FOR CHYLAMYDIA AND GONORRHEA IN
ARIZONA- A CLINICAL TOOL TO INCREASE PARTNER TREATMENT AND
DECREASE RE-INFECTION
Melanie Taylor, MD, MPH and Brandy Peterson, MPH
—————–——————————————————————————————————————
In Arizona, the rates of sexually transmitted diseases (STD) are steadily increasing. Treatment is
critically important to controlling these diseases, especially among adolescents, young adults, and
certain racial groups where rates remain high.
In April of 2008, Senate Bill 1078 was passed which amends ARS 32-1401.27 and 32-1854 to allow
allopathic, naturopathic, and osteopathic physicians, or physician assistants to dispense or prescribe
antimicrobial medications to contacts of patients with communicable diseases without an intervening
health assessment of the partner. The application of this statute, for STDs such as gonorrhea and
chlamydia, is referred to as expedited partner therapy (EPT). The law became effective September
26, 2008. EPT is now being utilized in all but 11 states. Registered nurse practitioners in Arizona
are also allowed to provide EPT as determined by the Arizona Board of Nursing.
The standard mechanism used to assure treatment of the partners of persons with chlamydia or
gonorrhea infection is patient referral, but this method has had only modest success. EPT should
be considered when standard patient referral is unlikely to result in proper treatment. The common
way EPT is implemented is patient-delivered partner therapy (PDPT).
Data has been collected from studies comparing the efficacy of EPT to standard partner therapy.
Some of these findings are summarized below:
 EPT is a useful option to facilitate partner referral among heterosexual men and women with
chlamydia or gonorrhea, and to prevent re-infection of patients with chlamydia or gonorrhea.
 EPT may be considered for pregnant partners. However, current studies did not include analyses
for this group. (Most pregnant women already have access to healthcare and are motivated to
protect the health of the fetus, factors that are likely to reduce the role of EPT.) All pregnant
women should be referred for comprehensive prenatal care that includes syphilis and HIV testing
in addition to chlamydia and gonorrhea. Neither azithromycin nor cefixime are contraindicated in
pregnancy.
 EPT is at least equivalent in efficacy to standard partner management for gonorrhea and
chlamydia.
 EPT is a cost-saving and cost-effective partner management strategy.







CURRENT RECOMMENDATIONS FOR EPT FOCUS ON THE
TREATMENT OF CHLAMYDIA AND GONORRHEA
Partners of persons with chlamydia should receive or be prescribed 1 gm azithromycin (four
250 mg tabs) to be taken as one dose.
Partners of persons with gonorrhea should receive or be prescribed 400 mg cefixime to be
taken as one dose.
Patient information sheets should accompany all directly dispensed antibiotics and/or
prescriptions for antibiotics. These information sheets are available at: http://www.azdhs.gov/
phs/oids/std/index.htm
Costs of medications used for partner treatment cannot be charged to your patient’s
insurance.

Page 2

EXPEDITED
PARTNER
THERAPY FOR
CHYLAMYDIA
AND
GONORRHEA
IN ARIZONA
A CLINICAL
TOOL TO
INCREASE
PARTNER
TREATMENT
AND
DECREASE
RE-INFECTION
Melanie Taylor,
MD, MPH and
Brandy Peterson,
MPH

Public Health Update






POINTS TO DISCUSS WITH PATIENTS
Patients and partners should not engage in sexual activity for 7 days
after taking the medication
Patients and partners should be referred for STD testing in 3 months
Discuss possible allergic reactions to antibiotics
Encourage patients to have partners seen by medical provider for
STD testing and treatment
Encourage patients to visit CDC website for more information on STD
at www.cdc.gov/std

For more information and frequently asked questions related to EPT
as well as partner information sheets in English and Spanish please
access the Arizona Department of Health Services STD website:
http://www.azdhs.gov/phs/oids/std/index.htm
Or contact your local health agency or:
Melanie Taylor, M.D., M.P.H.,
Medical Director, Office of HIV, STD, and Hepatitis C Services,
Arizona Department of Health Services
150 N. 18th Avenue, Suite 140, Phoenix, AZ 85007-3237
(602) 364-4666 or Fax: (602) 364-2119, taylorm@azdhs.gov
Additional References:
1. Golden MR, Whittington WLH, Handsfield HH, Effect of expedited treatment of sex
partners on recurrent or persistent gonorrhea or chlamydial infection. New England
Journal of Medicine. 2005;352 (7):676-85

Additional
guidance is
available on the
CDC STD website:
http://
www.cdc.gov/std/
ept/

2. Patient-delivered partner treatment with azithromycin to prevent repeated chlamydia
trachomatis infection among women: a randomized, controlled trial. Sexually
Transmitted Disease. 2003; 30(1):49-56
3. Patient-delivered partner treatment for male urethritis: a randomized, controlled
trial. Clinical Infectious Diseases. 2005;41:623-9.
4. Weblink to ARS 32-1401.27: http://www.azleg.state.az.us/FormatDocument.asp?
inDoc=/ars/32/01401.htm&Title=32&DocType=ARS
5. Centers for Disease Control and Prevention. Expedited partner therapy in the
management of sexually transmitted diseases. Atlanta, AG: US Department of Health
and Human Services. 2006. http://www.cdc.gov/std/treatment/EPTFinalReport2006.pdf
Accessed November, 10, 2008.
6. Legal status of expedited partner therapy (EPT) by state. http://www.cdc.gov/std/
ept/legal/default.htm. Accessed November 10, 2008.

Page 3

Public Health Update
FOLIC ACID AWARENESS WEEK, JANUARY 2009
TIM FLOOD, MD
Folic Acid Awareness Week occurs January 5-11, 2009. Physicians and
nurses are encouraged to educate patients about the benefits of the
vitamin folic acid, particularly its role in preventing spina bifida. Lifetime
economic costs associated with caring for a child with spina bifida range
from $500,000 to $1 million.
In 1992, the Centers for Disease Control and Prevention (CDC)
recommended that women of childbearing age consume 400 micrograms
of synthetic folic acid daily. Then in 1997-1998, the Food and Drug
Administration required the addition of synthetic folic acid to enriched
cereal-grain products. Fortification was associated with a 34% drop in
spina bifida rates in the U.S.,
Data collected by the Arizona Department of Health Services Birth
Defects Monitoring Program (ABDMP), which tracks the incidence of
neural tube defects, show that approximately 34 babies are born in
Arizona each year with spina bifida. The rate of spina bifida went from
4.95 cases per 10,000 live births during the pre-folic acid fortification
period to 4.16 per 10,000 live births post fortification. This 16% reduction
in Arizona’s occurrence of spina bifida falls somewhat short of the 34%
decrease seen nationally.
Significant racial and ethnic disparities exist for the incidence of spina
bifida. The rate for White non-Hispanics is 3.10 cases per 10,000 live
births (Figure 1). For Native Americans the rate is 5.13 (95% CI: 2.998.22) per 10,000 live births. For White Hispanics the rate is 4.97 (95%
CI: 3.99-5.95) per 10,000 live births; a statistically elevated rate
compared to that of White non-Hispanics.
10.0
Incidence Ra te (Ca ses per 10 ,0 00
Liv e Births)

Figure 1. Race/
ethnic rates of
spina bifida in
Arizona, for a
post fortification
period, 19992004. Bars
indicate 95%
confidence
intervals.
Source: AZ Birth
Defects
Monitoring
Program.

8.0
6.0

4.97

5.13

4.0
2.0

3.10
1.60

0.0
Black

Hispanic

Native Amer.

White, non-Hisp

Case Counts: Black (3); Hispanic (99); Native Am (17); White (non-Hisp) (75); Unknown (9)

FOLIC ACID
AWARENESS
WEEK
JANUARY 2009
Tim Flood, MD
http://azdhs.gov/phs/
bnp/folicacid/
http://www.getfolic.org/
http://www.cdc.gov/
ncbddd/folicacid

Page 4

FOLIC ACID
AWARENESS
WEEK,
JANUARY 2009
Tim Flood, MD
http://azdhs.gov/phs/
bnp/folicacid/
http://
www.getfolic.org/
http://www.cdc.gov/
ncbddd/folicacid

Public Health Update
Up to 70% of neural tube defects, such as spina bifida and anencephaly,
can be reduced by taking a folic acid supplement. Recognizing that
unplanned pregnancies account for half of all pregnancies in the United
States, the CDC and other organizations recommend that all women of
child bearing age take 400 micrograms of folic acid daily. Once
pregnancy is confirmed, the Institute of Medicine recommends increasing
the folic acid consumption. The March of Dimes Foundation notes that
most prenatal vitamins on the market contain between 800 and 1,000
micrograms of this essential nutrient. Women with a history of previous
children with spina bifida, or a family history, require a higher dose of folic
acid (4 mg daily) for subsequent pregnancies.
The average American’s diet is deficient in foods that contain natural
folate. Dietary folate can be obtained in foods such as green leafy
vegetables, beans, orange juice. Until the average diet improves, the
best strategy for reducing the occurrence of neural tube defects is to
recommend daily intake of synthetic folic acid. Given the disparities in
rates, Arizona’s Hispanic and Indian population can benefit most
significantly from efforts to promote folic acid.
Health care professionals can order educational materials to educate
patients year-round from: http://www.cdc.gov/ncbddd/folicacid/
health_materials.htm

EDITORS
Ken Komatsu
State
Epidemiologist
Rebecca
Sunenshine
Deputy
State
Epidemiologist

Questions or
comments
regarding this
publication
can be
emailed to:
christine.wampler
@azdhs.gov

For more information, please contact:
Adrienne Udarbe, RD
Maternal and Child Health Nutrition Manager
Arizona Department of Health Services
Tel: (602) 364-0451 or Adrienne.urdarbe@azdhs.gov
Additional References
1.

Spina Bifida Association. Retrieved October 31, 2008, http://
www.spinabifidaassociation.org

2.

CDC. http://www.cdc.gov/mmwr/preview/mmwrhtml/00019479.htm

3.

CDC, National Center for Health Statistics: Trends in spina bifida and anencephalus in
the United States, 1991-2005. Retrieved October 31, 2008, from http://www.cdc.gov/
nchs/products/pubs/pubd/hestats/spine_anen.htm

4.

Canfield M, et al. National estimates and race/ethnic-specific variation of selected birth
defects in the United States, 1999-2001. Birth Defects Research Part A: Clinical and
Molecular Teratology, 2006; 76(11), 747-747.

5.

The ABDMP counts both live and stillborn cases in the numerator for its calculations.
Data for births in 2004 is preliminary. This post-folic acid fortification rate is calculated for
births occurring October 1998 to 2003.

6.

CDC. http://www.cdc.gov/ncbddd/folicacid/faqs.htm

7.

March of Dimes Foundation. Professionals & researchers: Folic acid. Retrieved October
31, 2008, from http://www.marchofdimes.com/professionals/14332_1151.asp

To view previous Public Health Update and Prevention Bulletin publications, visit us on the web at:
http://www.azdhs.gov/diro/pio/preventionbulletin/