Effect of expedited treatment of sex partners on recurrent or persistent gonorrhea or chlamydial infection.
Open accessAbstract
BACKGROUND: Many sex partners of persons with gonorrhea or chlamydial infections are not treated, which leads to frequent reinfections and further transmission. METHODS: We randomly assigned women and heterosexual men with gonorrhea or chlamydial infection to have their partners receive expedited treatment or standard referral. Patients in the expedited-treatment group were offered medication to give to their sex partners, or if they preferred, study staff members contacted partners and provided them with medication without a clinical examination. Patients assigned to standard partner referral were advised to refer their partners for treatment and were offered assistance notifying partners. The primary outcome was persistent or recurrent gonorrhea or chlamydial infection in patients 3 to 19 weeks after treatment. RESULTS: Persistent or recurrent gonorrhea or chlamydial infection occurred in 121 of 931 patients (13 percent) assigned to standard partner referral and 92 of 929 (10 percent) assigned to expedited treatment of sexual partners (relative risk, 0.76; 95 percent confidence interval, 0.59 to 0.98). Expedited treatment was more effective than standard referral of partners in reducing persistent or recurrent infection among patients with gonorrhea (3 percent vs. 11 percent, P=0.01) than in those with chlamydial infection (11 percent vs. 13 percent, P=0.17) (P=0.05 for the comparison of treatment effects) and remained independently associated with a reduced risk of persistent or recurrent infection after adjustment for other predictors of infection at follow-up (relative risk, 0.75; 95 percent confidence interval, 0.57 to 0.97). Patients assigned to expedited treatment of sexual partners were significantly more likely than those assigned to standard referral of partners to report that all of their partners were treated and significantly less likely to report having sex with an untreated partner. CONCLUSIONS: Expedited treatment of sex partners reduces the rates of persistent or recurrent gonorrhea or chlamydial infection.
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All three U.S. trials reported that more partners were treated when patients were offered EPT.
“All three trials reported that more partners were treated when patients were offered EPT.”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [125]
In the enrollment and study population section (page not specified), this trial reports that patients offered expedited partner treatment were more likely to say all their partners were very likely to have been treated or tested negative. That supports the direction of the claim for this trial, but the measure includes negative tests rather than treatment alone, and this paper does not establish what all three trials reported. (LLM, conf=0.85)
Experimental — accuracy not yet measuredTwo U.S. trials reported statistically significant decreases in the rate of reinfection, and one observed a lower risk for persistent or recurrent infection that was statistically nonsignificant.
“Two reported statistically significant decreases in the rate of reinfection, and one observed a lower risk for persistent or recurrent infection that was statistically nonsignificant.”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [125]
Table 3 reports a statistically significant reduction in persistent or recurrent gonorrhea or chlamydial infection in this trial (relative risk 0.76, 95% CI 0.59–0.98). The introduction (section 677) also describes an earlier trial with a nonsignificant reduction, but the passages found do not establish the claimed second statistically significant trial. (LLM, conf=0.82)
Experimental — accuracy not yet measuredAcross EPT trials, reductions in chlamydia prevalence at follow-up were approximately 20%, and reductions in gonorrhea were approximately 50% at follow-up.
“However, across trials, reductions in chlamydia prevalence at follow-up were approximately 20%, and reductions in gonorrhea were approximately 50% at follow-up.”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [125]
The “gonorrhea and chlamydial infection at follow-up” section reports reductions with expedited partner treatment, but this trial’s figures are 15% for chlamydia and 73% for gonorrhea, not approximately 20% and 50%. The cited passage reports this trial’s results, not an estimate across trials. Page numbers are not provided in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredEvidence supporting EPT is based on three U.S. clinical trials involving heterosexual men and women with chlamydia or gonorrhea.
“Evidence supporting EPT is based on three U.S. clinical trials involving heterosexual men and women with chlamydia or gonorrhea (125–127).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [125]
U.S. trials and a meta-analysis of EPT revealed that the magnitude of reduction in reinfection of index patients, compared with patient referral, differed according to the STI and the sex of the index patient.
“U.S. trials and a meta-analysis of EPT revealed that the magnitude of reduction in reinfection of index patients, compared with patient referral, differed according to the STI and the sex of the index patient (110,125–127).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [125]
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- Authors
- Golden, M. R., Whittington, W. L. H., Handsfield, H. H., Hughes, J. P., Stamm, W. E., Hogben, M., Clark, A., Malinski, C., Helmers, J. R. L., Thomas, K. K., & Holmes, K. K.
- Affiliations
- Public Health – Seattle & King County (US)
- University of Washington (US)
- Centers for Disease Control and Prevention (US)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2005-02-17
- Volume
- 352
- Issue
- 7
- Pages
- 676-685
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2128708588
- Cited by
- 470
- References
- 25
- Citations by year
- 2026: 6 · 2025: 5 · 2024: 7 · 2023: 21 · 2022: 21 · 2021: 27 · 2020: 16 · 2019: 24 · 2018: 13 · 2017: 22 · 2016: 20 · 2015: 36 · 2014: 19 · 2013: 24 · 2012: 35
- FWCI
- 24.25
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Abbott Laboratories
- University of Washington
- National Institutes of Health
- Centers for Disease Control and Prevention
- National Institute of Allergy and Infectious Diseases (K23AI001846, K23-AI01846, AI31448)
- Topics
- Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
- Keywords
- gonorrhea, chlamydia, partner notification, expedited partner therapy, recurrent infections, persistent infection, sexually transmitted infections, partner treatment, men who have sex with men, women, reinfection prevention
- MeSH terms
- Adult, Anti-Bacterial Agents, Chlamydia Infections, Drug Therapy, Combination, Female, Follow-Up Studies, Gonorrhea, Humans, Male, Patient Compliance, Recurrence, Risk Factors, Sexual Partners, Multivariate Analysis, Contact Tracing, Azithromycin, Heterosexuality, Cefixime
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