Patient-Delivered Partner Treatment With Azithromycin to Prevent Repeated Chlamydia trachomatis Infection Among Women: A Randomized, Controlled Trial
Abstract
BACKGROUND: Repeated infection with C trachomatis increases the risk for serious sequelae: pelvic inflammatory disease, ectopic pregnancy, infertility, and chronic pelvic pain. A substantial proportion of women treated for C trachomatis infection are reinfected by an untreated male sex partner in the first several months after treatment. Effective strategies to ensure partner treatment are needed. GOAL: The goal of the study was to determine whether repeated infections with C trachomatis can be reduced by giving women doses of azithromycin to deliver to male sex partners. STUDY DESIGN: A multicenter randomized controlled trial was conducted among 1,787 women aged 14 to 34 years with uncomplicated C trachomatis genital infection diagnosed at family planning, adolescent, sexually transmitted disease, and primary care clinics or emergency or other hospital departments in five US cities. Women treated for infection were randomized to one of two groups: patient-delivered partner treatment (in which they were given a dose of azithromycin to deliver to each sex partner) or self-referral (in which they were asked to refer their sex partners for treatment). The main outcome measure was C trachomatis DNA detected by urine ligase chain reaction (LCR) or polymerase chain reaction (PCR) by 4 months after treatment. RESULTS: The characteristics of study participants enrolled in each arm were similar except for a small difference in the age distribution. Risk of reinfection was 20% lower among women in the patient-delivered partner treatment arm (87/728; 12%) than among those in the self-referral arm (106/726; 15%); however, this difference was not statistically significant (odds ratio, 0.80; 95% confidence interval, 0.62-1.05; = 0.102). Women in the patient-delivered partner treatment arm reported high compliance with the intervention (82%). CONCLUSION: Patient-delivered partner treatment for prevention of repeated infection among women is comparable to self-referral and may be an appropriate option for some patients.
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Across 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 [126]
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 [126]
Two 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 [126]
Evidence 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 [126]
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 [126]
Eleven studies compared expedited partner therapy versus simple patient referral among patients with chlamydial infection, trichomoniasis, gonorrhoea or chlamydia, HIV, herpes simplex virus-2, syphilis, or any STI syndrome.
“Eleven studies compared EPT versus simple patient referral among patients with chlamydial infection (99, 113), trichomoniasis (89, 90), gonorrhoea or chlamydia (94, 95, 114-116), HIV, herpes simplex virus-2, syphilis, chlamydial infection, gonorrhoea (pharyngeal and anal) (117), or any STI syndrome (108).”
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- Authors
- SCHILLINGER, J. A., KISSINGER, P., CALVET, H., WHITTINGTON, W. L. H., RANSOM, R. L., STERNBERG, M. R., BERMAN, S. M., KENT, C. K., MARTIN, D. H., OH, M. K., HANDSFIELD, H. H., BOLAN, G., MARKOWITZ, L. E., & FORTENBERRY, J. D.
- Affiliations
- Centers for Disease Control and Prevention (US)
- Tulane University (US)
- Department of Health and Human Services (US)
- University of Washington (US)
- San Francisco Department of Public Health (US)
- Louisiana State University Health Sciences Center New Orleans (US)
- Public Health – Seattle & King County (US)
- Corresponding author
- SCHILLINGER, JULIA A.
- RANSOM, RAY L.
- STERNBERG, MAYA R.
- BERMAN, STUART M.
- HANDSFIELD, H. HUNTER
- MARKOWITZ, LAURI E.
- ORCID
- Venue
- Sexually Transmitted Diseases
- Published
- 2003-01
- Volume
- 30
- Issue
- 1
- Pages
- 49-56
- ISSN
- 0148-5717 (ISSN-L)
- OpenAlex
- W2072744471
- Cited by
- 251
- References
- 24
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 3 · 2023: 10 · 2022: 5 · 2021: 10 · 2020: 8 · 2019: 11 · 2018: 6 · 2017: 13 · 2016: 8 · 2015: 13 · 2014: 7 · 2013: 11 · 2012: 16
- FWCI
- 12.32
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Sexually Transmitted Diseases (publishedVersion)
- PubMed (publishedVersion)
- 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
- Chlamydia trachomatis, reinfection, azithromycin, partner notification, self-referral, women, sexually transmitted infections, chlamydia screening, intervention adherence
- MeSH terms
- Adolescent, Adult, Anti-Bacterial Agents, Chlamydia Infections, Chlamydia trachomatis, DNA, Bacterial, Drug Administration Schedule, Female, Humans, Male, Preventive Health Services, Recurrence, Sexual Partners, United States, Polymerase Chain Reaction, Azithromycin, Ligase Chain Reaction
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