How has EPT progressed in the
U.S.?
Californiawasthefirststatetoexplicitly
allow EPT in 2001 and since then, many
states have followed suit.
6
An analysis of
state EPT laws by CDC in 2006 concluded
that only 10 states expressly permitted
EPT, but by 2010, CDC reported that
number had grown to 27 states.
7
As of
June, 2015, EPT was allowable in 37
states.
8
The maps to the right show the status
of EPT in the United States in 2006 and
2015. EPT is legally permissible in any
state shaded green; likely prohibited in red
states; and potentially allowable in yellow
states. EPT is legally permissible when
laws, or governing authorities, expressly
allow the practice or there are statutes that
adopt CDC’s STD treatment guidelines, which effectively
endorse EPT as long as there is no contrary statutory
provision.
9
Do state laws and policies really matter?
Given the success of EPT in reducing sexually transmitted
disease reinfections and the low risk of adverse effects
associated with its use, policy efforts have focused on
facilitating its practice.
A 2013 report analyzing the legal aspects of EPT and the
influenceofstatelawsandpoliciesontheuseofEPT,found
that explicit laws or regulations that permitted EPT were
associated with higher reports of individuals receiving EPT
among interviewed STD cases. The study suggested that laws
that authorize EPT may diminish provider concern for legal
liability, and that for jurisdictions wanting to use of EPT, the
study suggests supportive law and policies may be an effective
option for doing so.
10
Those states that do not allow EPT (red states in the map
above) often do not have an explicit statutory prohibition
against the use of EPT but instead, have statutes that contain
detailed stipulations about patient-provider relationships that in
practice make the provision of EPT unlawful.
In those states where EPT is potentially allowable (yellow
states in the above map), there are no statutes that would
prohibit EPT such as a requirement that physicians have a
preexisting relationship with the individual for whom he/she
is writing a prescription or providing medication, but these
statesoftenhaveotherprovisionsthatmakeEPTdifficultto
administer.
Which states have taken action on EPT?
Over the past decade, many state legislatures have taken
action to legalize EPT and/or make it allowable. NCSD has
been a part of the policy process in many of these states
by helping to biletul zilei cota 2 facilitate coalitions, creating
materials, and providing organizational support.
Most recently, several state legislatures and a city
council took steps to legalize and/or make EPT feasible.
Policymakers in Ohio, Maryland, Hawaii, Michigan,
Kentucky, West Virginia, Nebraska, Vermont, and the
District of Columbia have all taken steps in this direction.
The EPT legislation in all of these states was similar in
thateachmodifiedstatecodetoallowaproviderwithout
a preexisting relationship, or examination, to prescribe
or dispense antibiotics for STD treatment. In most cases,
EPT legislation also adds language to state codes to
protect health care providers from liability from any poor
outcomes associated with EPT use. While poor outcomes
are extremely rare
9
(there have been no reported adverse
effects from the use of EPT), physician associations tend to
be more comfortable with EPT legislation when it contains
liability protection. The Hawaii, Nebraska, and Vermont
legislatures successfully passed EPT bills in 2013, and
Michigan and DC passed EPT bills in 2014.
In states such as New York and Washington, where EPT is
available already, legislatures are working to either expand
the group of providers that can provide EPT or the diseases
that can be treated with EPT.
12
Remaining states where EPT is not available, such as Ohio,
continue to pursue changes to EPT policy as programs
across the US show EPT to be an effective strategy for STD
treatment and cost-saving preventative care.
13
What is the status of EPT
in our state?
Is EPT allowable in our state?
Our state’s regulation on a health care provid-
ers’ ability to prescribe STD treatment to a
patient’s partner(s) without prior medical
evaluation reads:
Almost 1.4 million cases of chlamydia and
almost 333,000 cases of gonorrhea were
reported in the U.S. in 2013.
14
In our state, the most recent data shows that
the number of chlamydia cases reported was:
In our state, the most recent data shows that
the number of gonorrhea cases reported was:
In addition to the public health benefits, EPT
could save the state money. An estimated $850
million is spent annually treating chlamydia
and gonorrhea in the U.S.15 EPT can decrease
health care costs by reducing the spread of
infections and reinfections, and the reliance
on public services to treat STDs. Please refer
to your state department of public health for
more state specific information.
CDC’s EPT endorsement
In 2006, CDC in its Sexually Transmitted Diseases
Treatment Guidelines, recommended EPT as an
evidenced-based option to manage chlamydia and
gonorrhea by treating the initial patient and any sex
partner(s) to prevent reinfection and curtail further
transmission.
16
EPT is also recommended in the updated
guidelines from 2010 and 2015. Since CDC’s 2006
recommendation, other organizations have supported EPT,
including the American Bar Association, American Medical
Association, Society for Adolescent Health and Medicine,
American Academy of Pediatrics, and American Congress
of Obstetricians and Gynecologists.
17
In addition to CDC’s recommendation of EPT, the 2015
CDC STD Guidelines explicitly recommend the delivery
of EPT by providing patients with appropriately packaged
medication as the preferred approach to EPT, as compared
toprovidingprescriptions.ThedataontheefficacyofEPT
through providing prescriptions is very limited, and many
personsdonotfillprescriptionsgiventothembytheir
partner.
18
What can state policymakers do?
EPT can be a challenging topic since each state has differ-
ent medical practice laws. In some states, regulations
by medical boards prohibit doctors from using EPT. In other
states, statutes may prevent the practice of EPT. CDC’s EPT
website (www.cdc.gov/std/ept/legal) can help legislators
understand the legal landscape in their state.
In addition, state policymakers can:
• LearnMore–Talktoyourstate’sSTDdirectortodiscussif
EPT can be implemented in your state and the potential
public health impact.
• EducateOthers–Talktootherpolicymakersabouthow
many people are infected with chlamydia and gonorrhea
and the consequences of persistent infections.
• TalktoUs–NCSDhasassistedanumberofstateswithEPT
policyeducationandwearereadytoprovideofficials
with information about EPT and its potential impact on STDs.
Contact us at: StatePolicy@ncsddc.org,
202-842- 4660, or visit www.ncsddc.org.
EPT is potentially allowable in Georgia; however,
legal barriers impede practice.
Dispensation to, or use by, a patient does not
expressly preclude subsequent provision of drugs
to a partner. However, Dispense means “to issue...
for subsequent administration to, or use by, a
patient.” Ga. Code Ann. § 43-34-23(a)(3.1). There
is no statutory requirement that a physician conduct
a physical examination prior to dispensing a drug
for use by a partner.
In 2014, 51,945 cases of chlamydia were reported in
Georgia. A rate of 519.9 cases per 100,000
population. Georgia is ranked 9th out of 50 states
for chlamydia.
In 2014, 13,770 cases of gonorrhea were reported in
Georgia. A rate of 137.8 cases per 100,000
population. Georgia is ranked 11th out of 50 states
for gonorrhea.
