EPT is permissible in 45 states, potentially allowable in 4 states (South Dakota, Kansas, Oklahoma, and Alabama), and only prohibited in one state (South Carolina).

• Legal status of EPT according to the CDC: https://www.cdc.gov/std/ept/legal/default.htm

Specifically, some states have amended their Public Health code to allow clinicians to provide patients with medication or a prescription to deliver to their sex partner(s) without a medical evaluation or clinical assessment of those partners. States with supportive EPT policies have language in the law which cites that if EPT is provided in accordance to the law, prescribers are not subject to liability, except in the case of gross negligence.

It is widely supported by professional medical and legal organizations including the CDC, American Medical Association, and American Bar Association.

Both of the medications most commonly dispensed for EPT, Azithromycin and Cefixime, are generally well tolerated.

EPT is permissible in 45 states, potentially allowable in 4 states (South Dakota, Kansas, Oklahoma, and Alabama), and only prohibited in one state (South Carolina).

• Legal status of EPT according to the CDC: https://www.cdc.gov/std/ept/legal/default.htm

Specifically, some states have amended their Public Health code to allow clinicians to provide patients with medication or a prescription to deliver to their sex partner(s) without a medical evaluation or clinical assessment of those partners. States with supportive EPT policies have language in the law which cites that if EPT is provided in accordance to the law, prescribers are not subject to liability, except in the case of gross negligence.

It is widely supported by professional medical and legal organizations including the CDC, American Medical Association, and American Bar Association.

EPT is intended for patients who are unable or unlikely to seek timely care. The preferred treatment is still if the partner seeks clinical services directly with a healthcare provider. When discussing options with the ED patient about treating their partner, use shared- decision making and consider some factors:

• Partner is uninsured

• Partner lacks a primary care provider

• Partner faces significant barriers (such as transportation) to accessing clinical services

• Partner is unwilling to seek timely care

EPT can be offered for sexual partners within the 60 days prior to ED encounter. If the last sexual encounter was more than 60 days prior, the most recent sexual partner should be treated.

There is no limit on how many partners can be provided treatment via EPT. EPT can be offered to some partners while the patient may opt for other partners strategies such as the patient referring the partner to a clinic.

If a partner is pregnant, every effort should be made to contact her for a referral to pregnancy services and/or pre-natal care, EPT is a last resort in this circumstance. Doxycline is contraindicated in pregnancy, but cefexime and azithromycin may still be used.

Check with your state and county health department as well as your hospital or health system for local guidelines. In general, EPT should not be used for the following:

• Suspected child abuse or sexual assault

• Concern for patient’s safety such as intimate partner violence

• If the partner has a known allergies to the antibiotics

• For patients who are co-infected with STIs other than chlamydia, gonorrhea or trichomoniasis (such as HIV, syphilis, hepatitis)

Some states require identifying information of the partner while in other states it can be prescribed without.

It can be conducted via prescription-EPT (index patient brings prescription to their partner for partner to fill), or medication-EPT (index patient brings medication to their partner). A study of patients treated in New York City found similar partner treatment rates via either method. (Oliver, Rogers, and Schillinger 2016)

EPT can be offered presumptively based on a clinical diagnosis, it does not need to be lab-confirmed. This is particulalry important in emergency departments where the results of STI tests will not usually come back for 1-2 days. Providing EPT without laboratory confirmation may be considered when the provider has a high clinical suspicion of infection and there is concern the patient will be lost to follow-up.

In typical cases, EPT can be paid for either by the primary patient as an out-of-pocket expense (the primary patient's health insurance will not pay for a prescription for a partner in most cases) or by the partner upon prescription pick-up. If the partner has health insurance, the partner can use the insurance at time of pick-up.

In some locations, county health departments have free EPT medication vouchers to pay for the cost of EPT at prescription pick-up. In certain areas such as in Michigan, the state department has a CDC-sponsored programs to pay for medications as a take-home pack from the ED.

A challenging element of offering empiric EPT in the ED encounter is the question of screening the partner for allergies. A patient and partner information sheet should be provided with the EPT prescription or medication to help guide the allergy screen. If a partners name and date of birth is known, the EPT prescription can be written for the specific partner. The benefit of this approach is that if filed at a pharmacy the partner uses to fill medications, the pharmacy will be able to screen for allergies based on the partners patient profile in the pharamcy's system. If the prescription is written to a nameless "expedited partner therapy" name, the pharmacist can ask the patient for their medication list and allergy history at the time of pickup.

Depending on the emergency department relationship with pharmacy and local agreements, medication for EPT may be dispensed as a take-home medication kit or prescribed.

If dispensed, the ED patient may pay the non-insurance price for the partner medication at the ED pharmacy or hospital pharmacy. Some health departments may have partnerships in place to aid in medication costs. Past studies have shown that partners are more likely ultimately take treatment if EPT is dispensing in a unit-use dose as part of a partner packet that includes medication, informational materials, and a clinic referral for follow up testing and counseling.

If prescribed, it may be a paper prescription, a call-in prescription or a faxed-in prescription. Local retail pharmacies understanding and interpretation of EPT laws may vary, so prior discussions with pharmacies specifically with filling nameless EPT prescriptions will ensure the partner has no obstacles for prescription pick-up.

ED clinicians should refer patients and partners for comprehensive healthcare. If EPT is provided, the partner should still be encouraged to seek follow-up care as soon as possible. These outpatient visits can help accomplish necessary evaluation, treatment and counseling:

• confirm the exposure

• examine and test the patient test for other STIs including HIV, syphilis, hepatitis

• ensure treatment

• provide vaccinations (such as HPV)

• counseling services such as family planning, healthy sexual practices and risk-reduction