ANNAPOLIS – Struggling to cope with stubbornly high rates of sexually transmitted diseases, public health officials in Baltimore are proposing a novel plan to allow people with chlamydia and gonorrhea to give medication to their sexual partners even if the partners have not first been examined by a health care worker.
“We have to try new things because Baltimore has a big problem with chlamydia and gonorrhea,” said Dr. Emily Erbelding, an associate professor at Johns Hopkins University School of Medicine and clinical director of Baltimore’s sexually transmitted disease program.
Legislation proposed by Sen. Nathaniel J. McFadden, D-Baltimore, would create a pilot program in the city in which chlamydia and gonorrhea patients would be able to pass on to their sexual partners medication they had been given by health care workers even though the partners themselves had not been seen or examined by a health care worker.
Baltimore consistently has had the highest number of cases of chlamydia and gonorrhea compared to other counties in Maryland, according to the city health department. Even though the number of cases of gonorrhea has been falling for the last several years and Chlamydia cases fell between 2004 and 2005, the rate of these diseases in Baltimore outpaces the national average. In 2005, there were 6,380 cases of chlamydia and 3,489 cases of gonorrhea.
“It’s still at a level that’s unacceptable,” said McFadden who was concerned that people would become “comfortable” with the lower levels, and feared that reckless sexual behavior could drive the rates back up.
The medications used to treat gonorrhea and chlamydia pose little risk to patients, according to the Centers for Disease Control and Prevention. In a CDC clinical trial cefixime and azithromycin was used to treat gonorrhea and azithromycin alone was used to treat chlamydia, without any negative effects.
“In all the trials we never had a serious adverse event reported,” said Matthew Hogben a behavioral scientist at the CDC. These medications have very low rates of toxicity, he added.
While the state pharmacy board supported the proposal, it expressed concerns about the implications on health care workers who give out medication without first examining the person who would be taking it.
“We think it is necessary, said LaVerne Naesea, executive director of the Maryland Board of Pharmacy. “It would be more beneficial than harmful to the city. However, there are some considerations that may place the practitioner in awkward positions.”
There is no state law on dispensing medications to patients to give to someone who is not a patient. Maryland is one of 28 states where this practice is not specifically banned. However, state law allows pharmacists to be subjected to disciplinary action if they fill prescriptions for individuals who did not see a doctor.
In one study in the journal Clinical Infectious Diseases, men with sexually transmitted diseases who were given medication to pass on to their sexual partner were less likely to be infected a month later, and more likely to report that the partner received treatment.
“If you have a patient in front of you, and they have a few sex partners, studies show that 30 to 60 percent will actually get treatment with the original patient telling them that they’ve been exposed and recommending that they go to a clinic,” Erbelding said.
Part of the problem, according to the study, is that there are insufficient public health resources to notify sexual partners when a patient is diagnosed with a sexually transmitted disease. In areas with high concentrations of sexually transmitted diseases, less than 20 percent of individuals with gonorrhea or chlamydia were interviewed by public health personnel for partner notification purposes.
“This bill would allow Baltimore to take a major step forward in the control of sexually transmitted disease,” said Dr. Joshua M. Sharfstein, Baltimore City Health Commissioner.
Sharfstein also noted the program’s potential to lower deaths and other diseases.
“When STDs are present, the chance of transmitting HIV is higher and infant mortality is higher.”