Expedited partner therapy for chlamydia trachomatis has had mixed efficacy in different populations, but data are lacking on the efficacy in a pregnant population.
Evaluate the real-world effectiveness of establishing a prenatal expedited partner therapy program in eradicating chlamydia before delivery. To examine the maternal and neonatal outcomes among women treated for chlamydia in pregnancy compared among those that received expedited partner therapy to those that underwent standard partner-referral testing and treatment.
An expedited partner therapy program was implemented on August 21, 2019 at a public hospital in a county with high chlamydia prevalence. Pregnant women were provided with single-dose packets of azithromycin to treat partner(s) following diagnosis of chlamydia. We prospectively studied pregnant women treated in the expedited partner therapy program who delivered at our institution in the same year and compared outcomes to a historical cohort from the year prior that had traditional partner-referral for testing and treatment. We excluded women with concurrent gonorrhea, human immunodeficiency virus, syphilis, or current intimate partner violence. The primary outcome was chlamydia reinfection or no-cure at repeat testing 4-6 weeks following treatment or at the 36-week prenatal care screening. Secondary outcomes included obstetric, maternal, and neonatal outcomes including prelabor rupture of membranes, chorioamnionitis, endometritis, neonatal intensive care unit admission, neonatal sepsis, pneumonia, and conjunctivitis.
The rate of chlamydia was 3.6% over a 2-year period in our delivered population. In the year following implementation of expedited partner therapy, 471 women (mean [SD] age, 23.8 [5.3] years) were diagnosed with chlamydia delivered at our institution, compared with 419 women (mean [SD] age, 23.4 [5.5] years) the previous year. There were no differences in race, parity, prenatal care attendance, or concomitant sexually transmitted infections. Compared to the pre-expedited partner therapy group, the frequency of reinfection in the post-expedited partner therapy group was not statistically different (60/471 (13%) versus 61/419 (15%), OR 0.86 (95%CI 0.58, 1.26)). In a per-protocol analysis, 72 (17%) of pre-expedited partner therapy and 389 (83%) of post-expedited partner therapy groups actually received expedited partner therapy; reinfection was not statistically different between groups (p=0.47). There were no differences in secondary outcomes, although a trend toward improved rates of endometritis was noted in the post-expedited partner therapy group (OR 0.13, 95%CI 0.02, 1.02).
Implementation of a prenatal expedited partner therapy program did not significantly affect the frequency of chlamydia reinfection before delivery. Treatment of chlamydia in an inner-city population has multiple factors that lead to successful treatment. Future efforts to reduce sexually transmitted infection and chlamydia reinfection rates in an at-risk population include exploring patient education and safe sex practices beyond expedited partner therapy alone during pregnancy.

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