From the Jane Fonda Center, Departments of Gynecology and Obstetrics.
Emergency Medicine.
Sex Transm Dis. 2021 Jul 1;48(7):474-480. doi: 10.1097/OLQ.0000000000001337.
Expedited partner therapy (EPT), the practice of prescribing antibiotics for sexual partners of patients, is underutilized in Georgia. This qualitative study in a large urban institution aimed to (1) characterize the clinical specialties that predominantly treat sexually transmitted infections (STIs), (2) identify perceived barriers to EPT, and (3) describe strategies to advance routine EPT use.
Providers in obstetrics/gynecology (OB/GYN), infectious disease (ID), and emergency medicine (EM) were interviewed using a structured discussion guide. Transcripts were double-coded and iteratively analyzed using qualitative content analysis. Barriers and strategies were summarized and supported with quotes from providers (n = 23).
Perceived EPT barriers overlapped across OB/GYN, ID, and EM, yet the settings were diverse in their patient populations, resources, and concerns. Providers in OB/GYN were the only ones practicing EPT, yet there was a lack of standardization. Providers in ID noted that an EPT prescription from an ID provider could inadvertently disclose the HIV status of a patient to a sexual partner, posing an ethical dilemma. Providers in EM exhibited readiness for EPT, although routine empiric treatment for index patients in EM (estimated at 90%) gave some providers pause in prescribing for partners: "I do not know what I'm treating." Point-of-care testing could increase providers' confidence in prescribing EPT, yet some worried it could contribute to overutilization of the emergency department as a sexually transmitted infection clinic. All settings prioritized setting-specific training and protocols.
Providers in OB/GYN, ID, and EM report unique hurdles, specific to their settings and patient populations; tailored EPT implementation strategies, particularly provider training, are urgently needed to improve patient/partner outcomes.
在格鲁吉亚，性伴侣治疗（EPT），即向患者的性伴侣开具抗生素的做法并未得到充分利用。本项在一家大型城市机构进行的定性研究旨在：(1) 描述主要治疗性传播感染（STI）的临床专科；(2) 确定 EPT 的实施障碍；(3) 描述推进常规 EPT 使用的策略。
使用结构化讨论指南对妇产科 (OB/GYN)、传染病 (ID) 和急诊医学 (EM) 的提供者进行访谈。使用定性内容分析对转录本进行双编码和迭代分析。总结障碍和策略，并提供提供者（n=23）的引语支持。
OB/GYN、ID 和 EM 中的提供者对 EPT 障碍的看法重叠，但各科室在患者群体、资源和关注点方面存在差异。OB/GYN 是唯一实施 EPT 的科室，但缺乏标准化。ID 提供者指出，ID 提供者开具的 EPT 处方可能会无意中向性伴侣披露患者的 HIV 状况，从而引发伦理困境。EM 提供者表现出对 EPT 的准备就绪，但由于 EM 中对索引患者的常规经验性治疗（估计为 90%）使一些提供者在为伴侣开处方时犹豫不决：“我不知道我在治疗什么。”即时检测可能会增加提供者开具 EPT 的信心，但一些人担心这可能会导致急诊部门过度利用，成为性传播感染诊所。所有科室都优先考虑特定科室的培训和方案。
OB/GYN、ID 和 EM 的提供者报告了特定于其科室和患者群体的独特障碍；迫切需要有针对性的 EPT 实施策略，特别是提供者培训，以改善患者/伴侣的结局。
