New Jersey lawmakers are seeking to give healthcare providers explicit permission to prescribe medicine for the sexual partner of someone they have diagnosed and treated for an STD — without meeting or examining the partner in advance.
Legislation to authorize so-called expedited partner therapy (EPT) is scheduled for a vote in the state Assembly Commerce Committee today; a companion version received the full support of the Senate health committee last week. Most states, including New York and Pennsylvania, have adopted similar laws in recent years.
Supporters of the Garden State proposal, which dates to 2016, consider it a sensible way to help curb the spread of highly contagious sexually transmitted diseases. Diagnoses of gonorrhea, syphilis and chlamydia — the three most common infections — have risen in recent years nationwide and in New Jersey, even though some studies suggest people are having less sex.
“Expedited partner therapy is essential to reducing the transmission of STDs,” said Casey Olesko, with Planned Parenthood Action Fund of New Jersey, which has tracked the spread of these infections. “We commend the bill sponsors for ensuring health care providers can use all of the tools available to fight this public health crisis.”
The proposal would allow specific providers to prescribe or directly dispense medications — typically antibiotics or antiviral drugs — to treat someone they have not diagnosed, if that person’s sexual partner tested positive for an STD and had a high likelihood of having passed on the infection during sex. The clinician would also need to treat the infected patient, based on the diagnosis, and would be protected from liability for prescribing to the partner under the bill.
After diagnosing an individual, doctors or nurses who adopt EPT protocols would provide the patient with treatment and also give them medications to pass on to the sexual partner who is not present. The provider would also need to share printed information about the disease, with enough copies for both individuals, and ask the patient to urge the partner to seek full treatment of their own.
The bill is currently silent on who would pay for the cost of the partner’s medication, if that person is not covered under the patient’s plan.
STDs on the rise statewide
In 2017, nearly 46,700 cases of sexually transmitted infections were diagnosed in New Jersey, state data shows; that was up from almost 40,000 in 2015, and 36,300 in 2013. A national analysis released earlier this year found the Garden State placed 32nd in the U.S. for its STD rates; the three states with the highest rates were Louisiana, Georgia and North Carolina.
Nationwide, STDs have been on the rise for at least four years, according to the federal Centers for Disease Control and Prevention, with gonorrhea diagnoses up 67 percent and syphilis cases spiking 76 percent in 2017 alone.
While these infections are generally treatable, a large number of cases are undiagnosed and therefore not addressed, the CDC notes. Without proper care, they can lead to infertility, pregnancy problems, stillbirths, and increased HIV risk. (Condom use significantly reduces the risk of transmission.)
Diagnosing and treating patients directly is still the preferred method, the federal agency notes. But to help reduce the spread of these diseases, the CDC also endorsed the remote therapy as “a useful option,” or alternative to the traditional approach. “Effective clinical management of patients with treatable sexually transmitted diseases (STDs) requires treatment of the patients’ current sex partners to prevent reinfection and curtail further transmission,” it said.
According to the CDC, 43 states — including the rest of the mid-Atlantic region and all of New England — have adopted laws or enacted policies that explicitly permit expedited partner therapy. Five states — including New Jersey, which has broad public health powers — plus Puerto Rico have policies that make the practice “potentially allowable,” it said, while Kentucky and South Carolina expressly prohibit EPT.
The New Jersey Department of Health maintains a fact sheet on EPT and has educated providers on the process, according to a representative, but is unable to encourage its use, since their license could become at jeopardy under current state law.
That would change under the proposed bill (A-4493), sponsored by Assembly members Nancy Pinkin (D-Middlesex), health committee chairman Dr. Herb Conaway (D-Gloucester), and Valerie Vainieri Huttle (D-Bergen).
Legal protection for doctors, nurses
As drafted, the Assembly plan would permit doctors, advance practice nurses and physicians’ assistants to use EPT for the partners of patients they are treating for sexual infections. The Senate version, by Sen. Joseph Vitale (D-Middlesex), who chairs the health committee, was amended last week to also include certified nurse midwives.
Under these proposals, the clinician could prescribe or dispense the partner’s medication in that person’s own name — if it were known — or under the generic heading “expedited partner treatment” if the individual’s identity were not known. The decision to do so would be based on a confirmed STD diagnosis in the patient as well as that patient’s assurance that they are “reasonably certain” they may have infected a sexual partner within the previous two months.
The bill calls for the DOH to adopt rules for the program and create the printed materials that doctors would distribute along with the prescriptions. These items must include potential drug warnings, clinical information about the disease, risk reduction tips and other information.
The legislation also provides legal protections to the doctor or nurse involved and stipulates that the patient’s insurance would not have to pay for the extra medications — unless the partner was directly covered by the patient’s policy, as a member of the family, for example.