Texas okays partner treatment for STD’s without an exam

TMB Allows Expedited Partner Therapy

I hadn’t heard this, and think it’s a generally good idea.

Physicians now may treat the sex partners of patients diagnosed with chlamydia or gonorrhea without first examining the partner, thanks to an amendment adopted by the Texas Medical Board (TMB).

The amendment allowing expedited partner therapy took effect June 24.

TMB amended its rules to allow a physician to provide for a person with whom he or she does not have a "proper professional relationship … the prescription of drugs for a partner of a patient who may have a sexually transmitted disease."

The Texas Register notice of the amendment says TMB "determined that the amendment to the rule addresses a serious public health issue and is intended to allow physicians to treat persons with sexually transmitted diseases as early as possible or prevent such persons from contracting sexually transmitted diseases from their partners. The board finds that the amendment will allow for the immediate treatment of sexually transmitted diseases contracted by partners of patients and therefore remove a current peril to the public health, safety or welfare."

The Texas Department of State Health Services has developed a fact sheet [PDF] on expedited partner therapy.

This specifically excludes treatment of men who have sex with men due to their need to be tested for HIV, etc.

From a Public Health standpoint this makes sense.  I wonder about how to write a prescription for a partner, and documentation requirements surrounding that.  Double the Rx for the patient in front of me and tell them to share their pills like other things?  Get the partners’ name, and write a second Rx (which then has me potentially writing a prescription to a patient who’s allergic to the medication…).

 

Advice from the peanut gallery?


Comments

  1. This is one of those issues that mainly illustrates how out of touch politicians are with the bureaucracy that more or less controls medicine. So what if some legislation is passed, if there isn’t some kind of consideration of how health insurance will respond to this kind of issue?

    Although I am an advocate of some kind of universal availability of health care, this is something that is not addressed in any of the various proposals for health care reform (or lack thereof).

  2. I’d be surprised if any doctors were willing to take on the liability issues of prescribing for patients they’ve never seen. In addition to allergies, there are other possible contraindications and drug interactions that would make this a very bad idea.

    Also, excluding only men who have sex with men makes no sense; the presence of another STI increases the likelihood of infection with HIV, regardless of gender preference. Approximately 1/4 of new AIDS cases are among women, the overwhelming majority of them sexually acquired.

  3. Glen in West Texas says:

    The key information from the Dept. of Health Services is that they only have staff to do contact tracing for Syphilis.

    Absent contact tracing, pills for partners will get some carriers treated who would not otherwise do so. Seems that only painful or very ugly infections cause folks to seek treatment on their own.

    So it will help a bit.

    Though I notice they say “nearly 31,600 cases of gonorrhea” reported in Texas in 2008. That’s definately a clue that reporting is not very accurate.

    Two off topic: Why is HIV still not considered a tracable STD? Second, what bonehead at CDC came up with phrase “men who have sex with men”. “Gay and bisexual men” seems a much better term.

    As an old sailor, I must admit that screening with treatment (reducing number of carriers) is the most effective form of prevention for STDs.

  4. Glen in West Texas says:

    To answer your question (rather than comment): It should be prescribed and dispensed in a booklet pack, one 400mg cefixime in a blister on each side. Book pack inside should have instructions in english and spanish. Outer cover one side pink, one side blue.

    Pink to female, blue to male. Include a date stamp on the outside cover (both), and instructions include directions to seek care of symptoms have not resolved in one week.

    script would be for “cefixime partner pack”, in name of the partner seeking treatment.

    Ideally, it would be better to dose the patient with 125 mg IM ceftriaxone, and give them a single blister pack to carry home to partner.

    Either option should be dispensed from the clinic or hospital, so that a pharmacy visit is not necessary.

    Funding for this will arrive on the Grassy Knoll at Dealey Plaza, delivered by flying saucer from Area 51.

  5. “This specifically excludes treatment of men who have sex with men due to their need to be tested for HIV, etc.”

    I had no idea only men having sex with men got HIV in Texas! This is an important scientific breakthrough which demands further investigation. In my office, if you’ve had unprotected sex, you’re a candidate for HIV testing.

    To Glen: “Men who have sex with men” is a clumsier, but better term than “gay or bisexual men.” It’s the preferred term in STD/epidemiology literature now. For some reason, a large number of men who do have sex with other men do not describe themselves as gay or bisexual (“I’m not gay-but I’m not doing without sex for this whole five year prison term.” “I’m not gay, but I do like sex with transsexual prostitutes.” “I’m not gay, I just really liked that blowjob the other guy gave me, and I’m going back for more next time my girlfriend’s out of town.”) Sexual identity isn’t always the same as sexual activity.

  6. Goatwhacker says:

    Although I’ve already done this on a rare occasion (without the blessing of the state board, it appears) in general I agree with Finn that prescribing meds for someone who isn’t your patient and you didn’t directly ask about allergies is asking for trouble.

  7. Aerospace Genius says:

    Patient B is responsible for his/her own self and is not entitled to mooch off Patient A. Tell patient A “This is why you need to take patient B to his/her doctor right now”. I can’t see the MD’s responsibility or authority extending beyond the patient that can be examined directly.

  8. Canuck Med Student says:

    “This specifically excludes treatment of men who have sex with men due to their need to be tested for HIV, etc.”

    How is this a positive thing? It’s blatantly homophobic and discriminatory. HIV is actually spreading more rapidly in the heterosexual population than the MSM population these days. This is at best discriminatory to your homosexual patients and at worst it’s dangerous to your straight patients.

    My advice- ignore this policy and tell everyone you work with to do the same. Any patient at risk of an STI at least deserves a conversation with you about their risk of HIV transmission, regardless of their sexual preference.

  9. “…advice from the peanut gallery”?

    If you had ever been my doctor you’d know I was allergic to peanuts!Agh! Cough! Snork! *croak.*

  10. Whoops, I forgot to add one thing to my comment: ;-)

  11. When writting the prescription you need to have a form that the partner that obtains the treatment signs that states that they are aware that the medication is being prescribed for the partner without and exam and there is no knowledge of an allergy. The partner is responsible for obtaining treatment if they are allergic to the prescribed treatment and the prescriber is not responsible for any adverse reaction related to the prescription.

    Or, the partner can also be sent to a Planned Parenthood clinic for low cost testing and treatment and education on STD prevention and safe sex practices and contraception options if needed.

  12. The musings so far seem to assume that there is only one sexual partner. My experience in the locations I work is that there are often 2-5 other individuals involved . Maybe these folks are somewhat friendlier than in other parts. The positivity is so high there, that if I even consider running the test, I go ahead and treat presumptively. These patients are notoriously difficult to contact three days later (They usually give fake contact information). One of our docs would not treat at all, unless frank purulence was observed on exam. “What’s the point of treating? They only go back to their partners and get reinfected.”

  13. It occured to me that that is a better way to do this than bagging the prescribing doc. Instead, the ED/PCP should be the referring doc for the “partners”. This would work: STD panel and copy of patients script forwarded to health department, with partner count. Withing 24 hours, they approve the partner packets. Email to pharmacy that dispensed original script. Text message to the original patient to notify them, or auto phone message.

    Liability would then rest with state, and would be much less of a problem. Setting the upper limit would be interesting problem. I’d say a max of around 5-7. I realize that would cover only a busy evening for some folks. It is worthwhile to treat every case, as it is not always futile.

    Of course, they could just go to county clinic, but that seems to not be a popular option.