![]() Īnother key issue affecting EPT with MSM are the variations in male same-sex partnership interactions between different social and cultural contexts. ![]() Accordingly, while EPT is recommended for use with MSM by the California Department of Public Health, national guidelines are inconsistent, and the CDC currently recommends caution in the use of EPT for partners of MSM, citing the need for additional clinical trial research prior to widespread use in this population. Clinical evidence on the use of EPT with MSM is limited the only previous randomized controlled trial (RCT) of EPT with partners of MSM was discontinued prior to completion due to a low rate of subject enrollment. The potential for the increased development of population-level antibiotic resistance further complicates empiric antibiotic use for exposed partners. Public health concerns that providing direct, partner-delivered access to oral antibiotic therapy for STI-exposed individuals may result in ineffective treatment and discourage them from seeking further testing and treatment services have impeded the introduction of EPT as a strategy for partner management of MSM with GC/CT infection. Most concerns surrounding the provision of EPT for sexual partners of MSM are based on the high prevalence of undiagnosed HIV, syphilis, and drug-resistant gonorrhea infections within their sexual networks. However, lingering questions concerning the use of EPT with sexual partners of men who have sex with men (MSM) have discouraged regular use of EPT in this population. As a result, the US Centers for Disease Control (CDC) currently recommends routine use of EPT for heterosexual men and women diagnosed with GC and/or CT infection. By providing a tool to support partner notification following an STI diagnosis, EPT has also been shown to promote notification of recent sexual partners. Previous clinical trials of EPT for partner management of urethral gonorrhea (GC), chlamydia (CT), and other bacterial STIs found that individuals randomized to receive EPT had significant reductions in the frequency of repeat or recurrent infection on subsequent re-testing. At the same time, by redirecting the public act of formally seeking STI care into a private interaction between sexual partners, EPT also circumvents social barriers to partner testing and treatment like stigma and shame. By providing direct access to antibiotics for an index patient’s recent sexual partners, EPT alleviates structural barriers like limited access to clinical services. By providing antibiotic therapy to the recent partners of STI-positive index patients, either through patient delivery or alternate methods of expedited access without a prescription, EPT removes key institutional and interpersonal barriers to treatment. Expedited Partner Therapy (EPT) provides an opportunity for the targeted delivery of sexually transmitted infection (STI) control interventions to high-risk sexual partnerships and networks.
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