Addressing partner treatment in STD counseling
When a woman tests positive for chlamydia or gonorrhea, it is protocol in our practice to treat the STD and provide counseling on possible treatment side effects, transmission and prevention.
Women diagnosed with STDs are prescribed appropriate medication, advised to take it exactly as directed, and asked to return to the office in three weeks to a month for a test of cure. We also ask these women to inform all current sexual partners of the diagnosis, and request they be tested and treated if positive.
It is not uncommon for these women to test positive on the test of cure, despite completing treatment as directed. The trouble seems to be with partner treatment.
The most common response I hear when I ask a patient if her partner was treated goes something like this: “I told him what I had, and he said he's fine and doesn't need any medication.”
Many times partners will insist that the woman got the STI from another partner or from a toilet seat. Some women report that their partners have no access to health care and were unable to be tested or treated.
So how should women's health-care providers properly address partner treatment for STDs?
Although we do not treat males in our practice, I often offer to speak to my patients' partners myself to discuss the STD diagnosis, and the need for testing and treatment. Currently, it is legal in 27 states for clinicians to provide expedited partner treatment (EPT) upon diagnosing chlamydia or gonorrhea. This practice is potentially allowable in 15 states and is prohibited in eight states.
EPT can be accomplished with patient-delivered partner therapy (PDPT) where the prescriber adds a refill to the prescription and instructs the patient to give the refill to her partner.
A less common option is accelerated partner therapy, in which the woman's provider contacts the partner, discusses the diagnosis and reviews the partner's medical history before providing treatment. In both types of therapies, the partner is encouraged to have a full medical and sexual health exam following treatment.
Many providers are nervous about the potential for liability with PDPT, even in states where it is allowable by law. Although data shows that PDPT improves STD treatment rates, many fear that more serious health concerns, as well as allergies and other drug interactions and the opportunity to educate patients, will be missed.
When it comes to partner STD treatment, there is no definitive best practice model, especially considering that laws differ from state to state. Open and honest patient-provider communication can help guide clinicians in deciding upon the most effective choice for each individual patient.
Robyn Carlisle, MSN, CNM, WHNP, works as a full-scope midwife at University Doctors and Kennedy University Hospital in Sewell, N.J.