Gonorrhea Outbreak Update and EPT to Treat Sex Partners

NH DPHS Health Alert NetworkOn December 20, 2017, NH DHHS issued a health alert with an update on the gonorrhea outbreak and information on expedited partner therapy (EPT) to treat sex partners.

Key Points and Recommendations:

  • Sex partners of patients diagnosed with any sexually transmitted disease should be connected with care and treated. We recommend that Expedited Partner Therapy (EPT) be utilized to treat heterosexual partners of men and women who are diagnosed with gonorrhea or chlamydia. EPT refers to when a healthcare provider gives antibiotics (or an antibiotic prescription) to their patient to take to his/her sex partner without the healthcare provider first examining the partner. Under NH law RSA 141-C:15-a, the practice of EPT is explicitly legal and allowable in NH; this law went into effect on May 9, 2017.
  • General guidance for EPT is as follows:
    • Recommended EPT treatment for gonorrhea is cefixime 400mg orally in a single dose PLUS azithromycin 1g orally in a single dose (Please note: cefixime should ONLY be used for EPT and not treatment of patients seen in clinic).
    • Recommended EPT treatment for chlamydia is azithromycin 1 gram orally in a single dose.
    • Healthcare providers should give treatment instructions with any medications or prescriptions as part of EPT. Guidance documents to assist healthcare providers with implementing EPT and handouts for patients and sex partners with treatment instructions are at: https://www.dhhs.nh.gov/dphs/bchs/std/ept.htm
  • New Hampshire continues to see high numbers of gonorrhea well above our previous baseline. Based on preliminary data, we project more than 500 cases for 2017.

  • 15% of individuals diagnosed with gonorrhea in 2017 did not initially receive correct treatment. While this is an improvement since our initial notification of the gonorrhea outbreak, we continue to ask clinicians to review the current 2015 STD treatment guidelines

  • Treatment of gonorrhea needs to include two different antibiotics to prevent emergence of antibiotic resistance. The Centers for Disease Control and Prevention (CDC) has listed gonorrhea as one of the top three national antibiotic resistant threats due to the propensity of Neisseria gonorrhoeae to develop resistance to antibiotics. Reports of ceftriaxone-resistant gonorrhea are beginning to emerge, including a recent report from Quebec, Canada.

  • Healthcare providers need to take sexual histories to identify patients at risk for gonorrhea in order to appropriately screen and identify the reservoir of subclinical or asymptomatic infection. Without appropriate sexual histories and screening, the high numbers of gonorrhea infection will continue from re-infection of patients and spread to new patients. 

  • Patients that are tested for gonorrhea should also be tested for other STDs including chlamydia, syphilis, and HIV. New Hampshire has also seen a concerning increase in syphilis cases: https://www.dhhs.nh.gov/dphs/cdcs/alerts/documents/syphilis-2017.pdf 

  • The NH Department of Health and Human Services, Division of Public Health Services (DPHS) will host a webinar updating clinicians about the gonorrhea outbreak, current treatment recommendations, and available resources on January 10, 2018 at 12:00 PM. Click here to register.  

  • Please report all cases of gonorrhea, along with any information about sex partners, to the NH DPHS at 603-271-4496.

Read the full DHHS alert