The Rules for Treating Partners of Patients with STDs
As a nurse practitioner working in the emergency department, I've become accustomed to treating patients for sexually transmitted infections. In fact, I do so nearly every shift I work. While having these sometimes awkward conversations with patients has become much easier, the waters surrounding treatment for the partners of these patients remains murky. Is it allowable to prescribe antibiotics for the partner of a patient I have never laid eyes on? What are the legal implications of doing so?
As antibiotic resistance increases, and healthcare providers continue to work in an increasingly litigious society, it's important that nurse practitioners review legal guidelines and think through their own positions on prescribing STD treatment for partners. This practice, known as Expedited Partner Therapy, is often permitted, and should be considered by NPs.
Expedited Partner Therapy (EPT) involves providing a patient's partner with medication or prescription for treatment of an STD without evaluation. Like most scope of practice guidelines, rules and regulations for Expedited Partner Therapy vary by state. Laws for the practice fall into three categories:
- Permissible - EPT is permitted even though the provider does not have a proper patient-provider relationship with the patient's partner.
- Potentially Allowable - EPT is not specifically outlawed, or specifically permitted by state law.
- Prohibited - State law specifically prohibits EPT.
Currently, Expedited Partner Therapy is permitted in 40 states, and potentially allowable in eight states. EPT is prohibited in two states, Kentucky and West Virginia. The map below, published by the CDC, depicts legality of EPT by state.
Although some form of EPT is permitted in most states, the exact guidelines surrounding the practice vary. In some states, for example, EPT may be permissible only for treating gonorrhea and chlamydia, but not other sexually transmitted diseases like syphilis. So, nurse practitioners must become familiar with the specific guidelines for EPT in the state where they practice.
Studies show that EPT works. One study, for example, found that of 977 men referred to a doctor by a partner, 43 percent had persistent or recurrent infection with gonorrhea or chlamydia compared to just 14 percent who used EPT. While the practice is effective, as nurse practitioners, concern about drawbacks of the practice are understandable. Could the partner experience a drug reaction or allergic reaction to the prescribed medication? What are the legal ramifications for the NP if such an event occurs?
Many healthcare providers are hesitant to prescribe for partners given these legal concerns. Is writing a prescription for a patient one has never seen, for an infection the patient may or may not have, really advisable? Partners of patients, however, often have barriers to treatment. These may be financial, insurance-related, or limited access to care. As nurse practitioners, in most states, prescribing treatment for STDs to partners of patient, in accordance with state guidelines involves relatively little risk. It does, however, ensure better outcomes for our patients, and prevents the spread of these infections overall.
Do you prescribe for partners of patients diagnosed with sexually transmitted infections?
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This was very informative. I went to grad school in a state where we emphasized treating the patients' partners for STD's, no gray areas. Once I graduated I relocated and based on the information you have provided, it looks like my state partially allows EPT. Great read. Thanks for the information.
Thanks for reading, Doris! Let us know if there are any topics that would be helpful for us to over on the blog as you near graduation.
Thank you for such an enlightened explanation. I did not know that some states allow that. I will definitely check my state law to get better understanding.
Thank you for all you amazing post. I will be graduating Np school next year by March. Please keep the advice coming.