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Reining in reinfection from sexually transmitted diseases

Reining in reinfection from sexually transmitted diseases

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Wisconsin legislators introduced a bill Thursday that would allow doctors to prescribe antibiotics to the partners of patients who have been diagnosed with sexually transmitted diseases, or STDs.

The Assembly Committee on Health and Healthcare Reform will hold a public hearing for the proposal on Wednesday, Jan. 20 at 10:30 a.m. in Room 417 North in the state Capitol.

Currently doctors in the state must see patients in person before writing prescriptions for them, which has meant that many partners of those infected with STDs go untreated, often because they do not realize they are infected or because they are reluctant or ashamed to identify themselves and seek help.

The practice, known as expedited partner therapy, would permit physicians who are treating an individual for gonorrhea, chlamydia or trichomoniasis to give the patient antibiotics to pass along to his or her partners, along with instructions and information about STDs and treatments.

The intervention would be a new weapon in the state’s battle against STDs, which are reaching epidemic levels here. About 30,000 cases of STDs were reported in Wisconsin last year, nearly half of them in Milwaukee, which has the second-highest rates of chlamydia and gonorrhea in the country. Experts say that thousands of more cases go undetected. Just among those age 15 to 19, the rate of STDs increased 53 percent between 1997 and 2007.

It is a national epidemic. Five of the 10 most common diseases reported to the Centers for Disease Control and Prevention now are STDs, which can cause cancer and other serious health problems, including death.

And it is a hidden epidemic, difficult to talk about and track, treat and prevent. STDs frequently have no symptoms, which means that many of those infected continue to spread them unknowingly.

Supporters hail the measure, which has been introduced over the past decade without much luck, as long overdue. “We have a rising number of sexually transmitted infections, and we have to do something about it. When you don’t treat the partners, they pass the disease back and forth, and that makes it very difficult to control this epidemic,” says Rep. Sandy Pasch, D-Whitefish Bay, a former nurse and lead sponsor of the bill.

The CDC recently launched a campaign aimed at encouraging states to adopt the approach, which now is used in 21 states, including Wisconsin’s neighbors Minnesota, Iowa and Illinois. According to information provided by the CDC, such intervention has been successful in those states in reducing rates of reinfection.

Public health officials say the bill would give their efforts a much needed boost since in recent years budget and staff cuts have decimated the ranks of teams assigned to fight STDs. In Dane County, about two-thirds of the eight public health nurses on the STD-HIV team have been reassigned to fight swine flu.

But critics worry the bill could create other health risks.

“We’re really concerned about a law that would allow pharmacists to present a medicine to someone they don’t ever see,” says Tom Engels, vice president for public affairs for the Pharmacy Society of Wisconsin, which opposes the measure. “It comes down to patient safety. The pharmacist won’t know anything about other medicines the patient might be on or potential allergic reactions.”

Officials with the state’s health department say that such risks are slim and are outweighed by the potential benefits of the bill, which takes a practical approach to what has been a problem — reaching partners of those infected with STDs.

“The best thing for someone who has an STD is for their partner to be seen by their own clinician. The challenge has been that that doesn’t occur,” says James Vergeront, program director with the state health department’s AIDS/HIV program. “This is not the ideal approach, but it enables us to extend our work force and reach individuals that wouldn’t be getting care otherwise.”

One of the huge barriers to halting the spread of STDs has been how to identify, contact, reach and treat infected partners. Sometimes infected men and women can not even name their sexual partners. Other times, they are too afraid or too embarrassed to inform their partners that they, too, might be at risk. But even when partners are notified, they often fail to seek testing and treatment themselves. Figures kept by the Madison and Dane County public health department show that public health nurses with the department’s STD/HIV team were able to reach only a fraction of partners of those with STD infections in 2007. Of the 1,714 cases of individuals with STDs assigned to them that year, nurses were able to interview 1,174; of the others, 518 were not located and 22 refused interviews. The 1,174 people with STDS nurses were able to interview gave out the names of 756 partners. Of these partners, nurses were able to contact 400. That means that fewer than a quarter of partners were contacted.

“We have to do something differently. Business as usual is not working,” Pasch says.

Similar legislation has been proposed in Wisconsin several times going back to 1999, but failed to advance in the Republican-controlled Legislature. This time, with Democrats in power, supporters are hopeful that the bill will pass. “The reasons it didn’t make it in the past probably don’t relate to the scientific merits but rather to some of the political challenges that sometimes even good policies face,” Vergeront says. “This is based on good science that shows this approach is effective in reducing the rates of reinfection.”

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