Free drugs may help more get chlamydia treatment

NEW YORK (Reuters Health) - Vouchers for free medication might help the sexual partners of people being treated for chlamydia get treatment too, a new study says.

Treating partners is important, the researchers note, because patients who have been treated can get chlamydia again from a partner who has the infection. Going to a clinic and seeing a doctor is still the best option for those partners.

But the study's authors say the vouchers are an option for people who might avoid clinics and never get treated to get the drugs they need without a prescription.

"Partners may not feel they have an STI (sexually transmitted infection)," Dr. Sharon Cameron, the lead author of the study and a gynecologist at the Dean Terrace Center in Edinburgh, Scotland told Reuters Health. Or, "they might be embarrassed to go to a clinic." This system "gives individuals another option of where they would want to go be treated."

Chlamydia is one of the most common STIs. In the U.S., around 1 percent of the population gets chlamydia every year. Young people age 15 to 24 are most at risk.

In the study, doctors gave out almost 600 vouchers to people diagnosed with chlamydia, most of them women. The vouchers allowed the sexual partners of those patients to go to a pharmacy and get a free dose of antibiotics used to treat the STI, which might otherwise cost around $20 if they didn't have insurance. If they preferred, the partners could go to a clinic to be tested and treated there.

Forty percent of the vouchers were redeemed at a pharmacy, most within a few days. Four percent of partners chose to get treatment at one of the clinics tracked by the authors instead. The researchers don't know whether the rest of the partners were treated by their primary care doctors or not at all.

Cameron said that these results are at least as good as what previous studies have shown for getting treatment to partners of people with chlamydia.

The voucher system is one way of getting medication in the hands of infected people quickly. Some states in the U.S. allow clinics to hand out extra antibiotics for patients to give to their sexual partners. But this isn't allowed in the UK.

One worry is that giving people antibiotics without a doctor's consult, either directly or through vouchers, could increase resistance to these drugs. The more antibiotics are used - and especially the more they are used for not enough time or at the wrong dose - the more likely that the infection will be able to fight off the drugs and become resistant to them. Resistant infections are more dangerous and costly to treat.

But Peter Carr, manager of the STD and HIV section at the Minnesota Department of Health, said the effect on resistance would not be significant. Resistance hasn't been an issue for chlamydia like it has been for gonorrhea, and "the effect on overall antibiotic use would be small," he told Reuters Health. "It would be a really tiny portion of the total antibiotics prescribed."

Then there are the ethical issues of giving people treatment when a doctor hasn't told them the drug's side effects or their other options. An American Medical Association (AMA) report on the ethics of giving patients medication for their sexual partners said that the technique could be used as a back-up for times when doctors don't think their patient's partners will see a doctor.

"There are ethical trade-offs in what we do," Dr. Mark Levine, the former chair of the AMA Council on Ethical and Judicial Affairs who was not involved in the study, told Reuters Health. "This is a means of getting treatment to more people than would be getting it using ... the traditional doctor-patient relationship that requires an in-person visit."

"The bottom line is if the partner's not going to get anyway, it's a way to make sure the partner does get treated," said Carr, who was also not involved in the study. "We think it's a valuable tool, and we need all the tools we can get for managing sexually transmitted infections in patients and their partners."

SOURCE: here

BJOG: An International Journal of Obstetrics and Gynecology, online May 25, 2010.