INTRODUCTION: The incidence of STIs, specifically gonorrhea, chlamydia, and trichomoniasis among Los Angeles County residents is on the rise. One possible explanation is inadequate treatment, especially of sexual partners. Expedited partner therapy (EPT) is a method of treating patients' partners without a separate healthcare visit, which has been shown to decrease persistent and/or recurrent infections. We report on quality improvement outcomes following interventions to help increase the rates of EPT provision. METHODS: Interventions included creating a protocol with the pharmacy, arranging for Cefixime to be on formulary, and conducting resident training sessions. Data collection was performed on all positive gonorrhea (GC), chlamydia (CT) and trichomoniasis lab results seen from January 1, 2017 to February 27, 2019 across all departments, inclusive of Ob/Gyn. EPT rates before and after interventions are presented. RESULTS: The rates of EPT prescriptions provided by OB/GYN providers for STI treatment increased following the interventions. EPT for GC/CT increased from 40% to 55% of cases; EPT for Trichomonas increased from 38% to 85%. Interestingly, patients were often counseled on the need for partner treatment, but were not given prescriptions. This study includes only female patients seen by Ob/Gyn providers, though the majority of results were detected in the emergency department by non Ob/Gyn providers. CONCLUSION: Following interventions aimed at establishing agreements with the pharmacy as well as increasing awareness among residents, the EPT rates of gonorrhea, chlamydia, and trichomoniasis did increase significantly. This may assist with decreasing the rate of STI reinfection among County hospitals and hospitals supported by medical trainees.

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INTRODUCTION: Rising rates of gonorrhea (GC) and chlamydia (CT) in Los Angeles County may be related to the inadequate notification/treatment of sexual partners, leading to cycles of treatment and reinfection. Expedited partner therapy (EPT) is a proposed solution that provides prescriptions/antibiotics directly to an affected patient's partner without a separate visit. EPT is approved in California for GC/CT treatment; however its distribution varies, warranting an examination of factors influencing partner notification and EPT distribution. METHODS: Institutional Review Board approval was obtained. Patients with positive GC/CT lab results from 1/2015 to 6/2017 were identified from LA County hospital electronic medical records. Documentation of the need to treat the patient's partner and/or EPT provision was identified, along with possible associated factors, e.g. the patient demographics, as well as the provider's specialty and training level. Descriptive statistics and bivariate comparisons identified correlations between receipt of EPT and possible factors. RESULTS: Of 319 GC/CT diagnoses, only 7.5% had EPT documented. More diagnoses occurred among female than male patients (63.6% vs. 36.4%) with males being less likely to be offered EPT (0.9% vs. 11.3%, P<.01). Patient age, race, and marital status were not associated with receiving EPT. Most diagnoses (60.2%) occurred in the emergency department, but those patients were least likely to receive EPT (3.7%, P<.01). Gynecologists were most likely to provide EPT (37.8%, P<.01). CONCLUSION: EPT was rarely offered to patients diagnosed with GC/CT, with provision least likely among male patients and in the emergency department setting. Gender-based and structural barriers may underlie low rates of EPT provision.

INTRODUCTION: Trichomoniasis is the most common, non-viral sexually transmitted infection (STI) worldwide. Cases are frequently asymptomatic in men and men traditionally are not screened, possibly contributing to high rates of reinfection among women. Expedited partner therapy (EPT) is a proposed solution that provides empiric STI treatment for an infected female patient's male partner without requiring a separate healthcare visit. EPT is legal in California and commonly given for gonorrhea and chlamydia; however, EPT provision for trichomonas is inconsistent, thereby warranting further study. METHODS: Institutional Review Board approval was obtained. Patients testing positive for trichomonas were identified from electronic medical records within the LA County hospital network, from 1/2015 to 6/2017. Documentation of partner treatment discussion and EPT provision was identified, along with potential associated factors, e.g. patient demographics and medical specialization. Descriptive statistics and bivariate comparisons were used to describe potential associations. RESULTS: Of 326 female patients testing positive for trichomonas, 34.5% identified as black, 33.2% as Hispanic/Latina. Only 57.9% of patients received some form of partner counseling; only 13.3% were offered EPT. Emergency medicine providers diagnosed trichomoniasis most frequently (51.8%), but only 38.6% offered verbal partner counseling and only 6.6% offered EPT. Family medicine providers were most likely to offer verbal partner counseling (66.7%, P<.01); gynecologists were most likely to offer EPT (25.5%, P<.01). CONCLUSION: Patients with trichomoniasis were not routinely offered EPT nor counseled about partner treatment in this population. Healthcare providers, regardless of specialty, should be reminded to recommend the screening and treatment of male partners and/or provide EPT directly.