Welcome Back: Adolescents willing to receive STI treatment, according to study

A recent study showed that many adolescents have the confidence to take ownership of their sexual health when faced with a sexually transmitted infection. 

Ana Radovic, a third-year Adolescent Medicine Fellow at UPMC Children’s Hospital of Pittsburgh, and her colleagues, Gina Sucato and Gale Burstein, conducted a survey to determine adolescents’ willingness to participate in Expedited Partner Therapy (EPT). Sexually Transmitted Disease, the official journal of the American Sexually Transmitted Diseases Association, published the study in its November 2013 issue.  

Expedited Partner Therapy is a practice that allows a patient diagnosed with a sexually transmitted infection to pass treatment on to his or her partner. For instance, the health care provider either writes a prescription for the diagnosed patient that includes extra medicine for a partner or writes a prescription in the partner’s name. 

Radovic said the main benefit of the treatment is that patients’ partners don’t have to see a doctor to receive treatment for a mutual infection.

According to Radovic, if the patient receives treatment, but his or her current sexual partner still carries the infection, then the patient can contract the disease again through further sexual intercourse. EPT can prevent the possibility of reinfection because both partners receive treatment. 

The practice of EPT varies by state depending on prescription laws. In Pennsylvania, EPT is permissible, according to the Centers for Disease Control and Prevention website. While no law bars healthcare providers from practicing EPT, no explicit laws exist to regulate its use.

Radovic collected data from patients at the Adolescent Medicine Clinic of Children’s Hospital, located in Oakland, for two months in 2010 during her pediatrics residency at Children’s Hospital. Burstein collected information from patients at the Women and Children’s Hospital of Buffalo Adolescent Clinic in Buffalo, N.Y. Radovic completed the study with funding from her post-doctoral grant through the Agency for Healthcare Research and Quality, which is operated by the U.S. Department of Health and Human Services. 

A total of 392 adolescents between the ages of 13 and 22 participated in the study. 

About 85 percent of participants said they would be willing to utilize EPT if they were diagnosed with chlamydia. This rate was the same in males and females, as well as patients who were sexually active and those who had never engaged in sexual activity. According to the study, adolescents with higher levels of education and self-efficacy were more likely to accept EPT as a treatment option. 

“I think I was surprised because you have to be pretty mature and confident to be able to carry out something like EPT,” Radovic said. “You have to be able to explain what it’s for and have that communication with the partner, so I think it just shows that adolescents are prepared to take initiative for their own sexual health.”

The colleagues researched adolescents’ acceptance of EPT because they said doctors often apply data from clinical practice studies on adults to clinical practice in adolescents. Radovic said aspects of adolescent psychology, including the types of romantic relationships they have and how close they feel to their partners, might impact their willingness to participate in EPT differently than adults. 

According to Sucato, researchers conduct far fewer studies on adolescents or pediatric patients compared to adults in every aspect of medicine, but especially sexual health. 

“When it comes specifically to studies around sexual health issues, I think it is always a little more complicated to study adolescents, so there are always more studies of adults than adolescents,” Sucato said.

According to Radovic, cases of sexually transmitted diseases, such as gonorrhea and chlamydia, occur most frequently among adolescents. About half of all new sexually transmitted infections occur in young people between the ages of 15 and 24, according to a report from the CDC published in February 2013.

Radovic focused the study on chlamydia because it is one of the most common sexually transmitted infections.

Chlamydia is the most commonly reported STI in the United States, and a large number of cases go unreported, according to the CDC.

Because patients have developed more resistance to antibiotics, the most effective treatment for gonorrhea is currently a shot, which a patient cannot take to his or her partner. Resistance occurs when a bacteria, in this case gonorrhea, modifies itself to no longer respond to a certain antibiotic. This generally happens when doctors use an antibiotic in large amounts. Health care professionals must, in turn, find another antibiotic to kill the bacteria. 

Health care providers typically prescribe one-gram doses of azithromycin, an antibiotic, to treat chlamydia, Burstein said. She added that reactions to the antibiotic, such as nausea and vomiting, are typically mild and unlikely with such a small dose. 

“There’s risks to taking any medication, even Tylenol per se, but the risks to taking azithromycin are actually very small,” Burstein said.

Elian Rosenfeld, a doctoral candidate at Pitt’s School of Public Health, is currently conducting qualitative research for her dissertation to determine health care providers’ perspective on EPT. Rosenfeld plans to utilize information from 25 in-depth interviews with health care providers to produce a survey for a wider pool of providers.

EPT can prevent the infection of women, according to Rosenfeld, if their male partners receive treatment for an infection. She said infected women are more likely to recognize their infection if they make annual visits to an obstetrician-gynecologist, whereas men are more likely to go untested and, therefore, undiagnosed. 

“I do think it is a really beneficial way to get a partner treated who might not usually get treated,” Rosenfeld said. 

Rosenfeld said she is not surprised that so many adolescents said they would participate in EPT. 

“Nobody wants to have an STI, and treating a partner is a great way to prevent that,” she said. 

If patients choose not to participate in EPT, Radovic suggests they use Sotheycanknow.org as a resource to help them notify their partners of an infection. 

So They Can Know is a website that offers people scripts to help guide the conversation about an infection with a partner in person, via phone, text message or email. The site also enables users to send an anonymous email to their partners to notify them of a possible infection.

Jessica Ladd, the executive director and founder of the nonprofit Sexual Health Innovations, developed the idea for So They Can Know about four years ago after teaching sexual education. Ladd and other volunteers launched the website in September 2012. Since its launch, she said about 19,000 users have visited the site. 

“One of the things that would always come up with my students when I was talking about STDs was that the idea of symptoms or further disease or health complications didn’t really freak anyone out,” Ladd said. “But the idea of having to call up and tell everyone you’ve slept with that they need to get tested was terrifying.”

She said the site does not store any information about users or their partners, and she hopes to add an anonymous text messaging feature by March of 2014. Ladd added that 92 U.S. clinics — a majority of which serve patients under the age of 26 — promote So They Can Know.

Ladd said that while patients should ideally notify their partners themselves, it is not always a patient’s best option. She said current partners typically utilize EPT, while anonymous notifications could be more useful for past partners. 

“If you had a bad break up, if you’re worried about your partner getting violent, something like that, then maybe anonymous notification is the better answer,” she said. 

Ladd said she hopes that partners who receive medicine or a prescription though EPT still get tested for an infection.

“They don’t necessarily know whether or not they actually got it or whether or not they actually have to go and tell their own partners unless they have an actual diagnosis,” she said.