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Clinical sciences poster session 1: and related syndromes
P3-S1.10 Using electronic medical record data to guide expedited partner therapy implementation in an urban STD clinic system, 2009
  1. T Mulder1,
  2. K Johnson2,
  3. A Lifflander2,
  4. J Schillinger2,
  5. M Rogers2,
  6. S Blank2
  1. 1US Centers for Disease Control and Prevention, Atlanta, USA
  2. 2NYC Department of Health, US Centers for Disease Control and Prevention, New York, USA

Abstract

Background Expedited partner therapy (EPT) is the practice of providing treatment without a clinical assessment to sex partners of patients with a diagnosed STD. EPT is legal for Chlamydia trachomatis (CT) infections in New York State. To guide EPT implementation at New York City STD (NYC STD) clinics, we estimated potential EPT use and EPT treatments to dispense.

Methods We analysed electronic medical record data for heterosexual patient visits to NYC STD clinics in 2009. To estimate potential EPT use, we measured: proportion clinic patients with presumptive diagnosis of mucopurulent cervicitis (MPC); nonspecific urethritis (NGU); contacts of both who tested positive for CT; patients with laboratory-confirmed genital CT infection; and proportion treated on day of visit. To guide policy on EPT treatments to dispense, we measured the median number of sex partners reported by CT-infected persons in the previous 3 months. To determine whether to route CT contacts to a physician (MD) visit (full STD evaluation) or an express visit (EV), we assessed STD diagnoses among CT contacts.

Results Among clinic patients with presumptive diagnoses of MPC, NGU, and contacts of both, CT prevalence was MPC, 14% (293/2144); MPC contact, 15% (38/257); NGU, 23% (1553/6744); and NGU contact, 17% (113/677). Of 40 099 patients tested for CT, 13% (5402/40 099) had a laboratory-confirmed CT infection. Of those, 79% (4288/5402) had been treated presumptively on day of visit. Males (n=4551) and females (n=3186) reported a median of two and one sex partners, respectively. Of 3561 contacts with CT diagnosis, 2339 (66%) were asymptomatic on day of visit and were routed to EV. Of those, 936 (40%) had >1 diagnosis other than CT; 22% of those (205) had a diagnosis of herpes simplex virus, human papillomavirus, trichomoniasis, or bacterial vaginosis.

Conclusion EPT is recommended only for heterosexual patients with laboratory-confirmed CT diagnosis because CT-prevalence was low among patients presumptively diagnosed with either MPC or NGU and their contacts. Approximately 20% of CT-infected persons qualify for EPT; the majority of CT-infected persons are treated on day of visit. EPT-eligible patients should be offered up to three treatments for sex partners. Asymptomatic CT contacts reporting they have taken EPT should be routed to EV; those who report not taking EPT should be routed to an MD visit regardless of symptoms. Symptomatic CT contacts should receive an MD visit.

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