- Spring 2005-

Immediate Access to Antibiotics Halts Spread of Sexually Transmitted Diseases

In an editorial published in The New England Journal of Medicine, researchers at Johns Hopkins supported a study which showed that providing faster, more direct access to antibiotics for partners of newly infected patients reduces re-infection rates and spread of sexually transmitted diseases, such as Gonorrhea and Chlamydia, compared to standard practice.

In the study, treatment was accelerated by providing packets of antibiotics or mailing medication directly to partners from the pharmacy, without first requiring examination of the partner by a physician. This "expedited treatment" resulted in 68% fewer re-infections with gonorrhea and 18% fewer re-infections with Chlamydia (or 24%, overall, when results for both diseases were combined), according to the study report.

The expedited approach is controversial, says the Johns Hopkins researchers, because most state laws, with the exception of California and Tennessee, do not allow distribution of antibiotics without a physician's examination.

"Traditional approaches to informing partners-in which the patients themselves must notify their sexual partners, who are then expected to seek medical evaluation and treatment-simply do not work well enough, as many patients fail to properly inform their partners, and many partners fail to seek treatment, which leads to re-infection," says lead editorial author and infectious disease specialist Emily Erbelding, M.D., M.P.H., an associate professor at The Johns Hopkins University School of Medicine. "These STDs are persistent in the United States. We are not making much headway in further reducing their overall incidence, and the standard approach to treating partners is one obstacle.

Currently, fewer than 20% of local health departments in the United States offer assistance with notifying partners to patients with Gonorrhea and Chlamydia, leaving most patients, often those in the poorest communities with limited resources, to make arrangements on their own for the partner's care."

The 2003 rate for Gonorrhea in the United States, the most recent available, is 117 per 100,000 people. This figure is nowhere near meeting the objectives of the federal Department of Health and Human Services' 2010 Healthy People Initiative, which is 19 per 100,000, Erbelding adds.

"The study's results should encourage physicians and public health policy advocates to incorporate expedited, patient-delivered therapy of antibiotics into their practices to effectively treat partners and control the spread of STDs, such as Gonorrhea and Chlamydia," says editorial co-author and infectious disease specialist Jonathan Zenilman, M.D., a professor at Johns Hopkins. "This approach had the added benefit of serving as a model for public-private approaches to public health problems. With this approach, no additional public funding would be required to expand the number of field staff to offer partner notification services. Treatment was delivered to a high proportion of the group exposed to the STD. Privately run, local pharmacies willingly participated in the program. If legislators are prepared to relax current restrictions on dispensing, as did Washington state for this study, then it could be effective elsewhere in cities where high rates of Gonorrhea and Chlamydia remain persistent problems despite efforts to apply standard health approaches."