The sex partners of persons with Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) infection must be treated to prevent repeat infection of the index patient and to interrupt forward transmission of disease. Asking patients to refer sex partner(s) for evaluation and treatment (‘patient referral’) is an inadequate strategy, as many sex partners will not seek care, and the large burden of CT and GC infections makes it impractical and cost prohibitive to rely upon health care providers or public health field investigators to assure partner treatment. Although no single sex partner treatment approach will be a panacea, innovative strategies are clearly needed.

This session will focus on strategies that do not require sex partners to attend a clinic to obtain treatment for CT or GC. The presenter will describe two models: (1) Expedited Partner Therapy (EPT), used in many parts of the US, includes patient delivered partner therapy, wherein a patient is asked to deliver medication or a prescription to their sex partner; (2) Accelerated Partner Therapy (APT), studied in the UK, uses clinician-staffed hotlines or pharmacists to assess the health status of sex partners before arranging for treatment. APT is being evaluated in a community-based randomised controlled trial, and efficacy data are not yet available, however, EPT has been shown to reduce risk for repeat GC infection by 68% and repeat CT by 20%. In practise, uptake and effectiveness of EPT has been limited by a variety of implementation challenges. The session will describe and - where possible - quantify obstacles to EPT, including: legal issues (perceived and real), lack of provider and pharmacist knowledge, patient preference and acceptability (for example, as few as 50% of eligible patients accept EPT for CT), medication costs, use of prescriptions rather than dispensing medication, and the emergence of cephalosporin resistance among GC.