Hard Call: Your Girlfriend Has Chlamydia, May I Phone In Your Prescription?

(tbone_sandwich/Flickr Creative Commons via Compfight)

(tbone_sandwich/Flickr Creative Commons via Compfight)

By Dr. Myechia Minter-Jordan
Guest contributor

Eighteen-year-old Eva had recently had unprotected sex with her boyfriend and came into my office for an urgent appointment to get “checked out.”

While I performed my usual cervical exam and testing, I used my 20-minute visit to talk with Eva (not her real name) about self-empowerment and the importance of protecting herself from disease: 
“I am really glad that you’re here with me today. This is an important first step in taking charge of your health and learning how to take care of yourself…”

The next day I found out that unfortunately, Eva had contracted chlamydia, the most common sexually transmitted disease in the country and the state. My next moves were clear: The job of informing my young patient of her infection is one that I am used to, but never look forward to. What is even less comfortable is the task of informing and treating the partner, an individual who is most likely not my patient, and with whom I do not have a relationship.

However, because of state legislation passed in 2011, I now have the ability to prescribe or dispense antibiotics to treat chlamydia in the sex partner of patients with diagnosed infection. “Expedited Partner Therapy” does not require a provider to examine the partner prior to treatment. Research studies have shown that the treatment is safe and effective in reducing chlamydia infection compared to the traditional practice of just notifying — but not treating — the partner. Additionally, in several other states that have Partner Therapy programs, there have been no reports of adverse events.

Eva and I made this difficult call together. We weathered the denial, shock and anger from her boyfriend. It took a minute to shift the conversation from blame to education, then learning and most importantly, assurance. I assured Eva’s boyfriend that this disease was treatable and this was an opportunity to get treatment and get better.

Yes, such calls are hard, but necessary. Over the last ten years, cases of chlamydia in Massachusetts have more than doubled from 8,725 in 1999 to 18,811 in 2009, according to the Massachusetts Department of Public Health.

This disease is overwhelmingly a scourge of the young. In fact, the incidence of reported infection for adolescents and young adults is more than four times the overall Massachusetts chlamydia infection rate per 100,000. Yet, in spite of its increasing prevalence, chlamydia is often undiagnosed because it is usually asymptomatic.

Without signs of obvious infection, patients are at risk of remaining untreated, passing the disease unknowingly or becoming reinfected after treatment. If left untreated, chlamydia can cause serious damage to a woman’s reproductive system, making it difficult or even impossible to get pregnant in the future.

Anyone who has unprotected sex can get chlamydia through anal, vaginal, or oral sex. However, sexually active young people are at higher risk, due to behaviors and biological factors common among the younger demographic. Men who have sex with other men are also in a higher risk demographic. Most people who have chlamydia have no symptoms. If you do have symptoms, they may not appear until several weeks after you have sex with an infected partner.

Symptoms in women may include:
• An abnormal vaginal discharge
• A burning sensation when urinating

Symptoms in men may include:
• A discharge from their penis
• A burning sensation when urinating;
• Pain and swelling in one or both testicles (although this is less common)

As Eva and I spoke with her boyfriend, I gave them information about the infection and treatment. He and I worked together to find the pharmacy closest to him so that I could call in his prescription. Although it wasn’t easy or comfortable for any of us, I think we all knew this was something that we had to do.

As a primary care provider, I see the bigger picture: the obligation that we all have to public health. Eva and her boyfriend were doing their part; it’s up to us as health care providers to help them — to take advantage of the license we now have to treat sexual partners as well. I hope this post will encourage and empower more young people to fearlessly seek help not only for themselves but for their partners. We are here to support you.

Dr Myechia Minter-Jordan is president and CEO of the Dimock Center, a nationally recognized community health center in Roxbury.

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  • ThirdWayForward

    This work is very important and we commend the article for raising awareness about this disease.

    However, huge improvements can be made in the way that diseases are discussed.
    Although this is all too common in public health reporting, it is
    all but completely meaningless to give a relative rate (‘more than four times
    the overall … infection rate”) without the absolute base rates. This is a bugaboo of ours.

    “This disease is overwhelmingly a scourge of the young.
    In fact, the incidence of reported infection for adolescents and young
    adults is more than four times the overall Massachusetts chlamydia
    infection rate per 100,000. Yet, in spite of its increasing prevalence,
    chlamydia is often undiagnosed because it is usually asymptomatic.”

    How probable is it that your partner in Massachusetts has chlamydia? This is the information that your patients really need to know. If it is one in a ten or even one in a hundred, then that is a signifant risk. but few people will take this seriously if they don’t have any idea about what that ballpark risk is.

    How many people are going to divide 18,000 annual cases by 7 million MA
    residents in their heads and then factor in the proportion of the
    population that is in their age group? The answer for the whole MA population is 0.26%, or roughly 1 in 400 MA residents will present with a case of chlamydia each year.

    If they don’t have any idea what that risk is and they are asymptomatic, then they won’t think to get tested for it when they see their doctors.

    What do you estimate is the real rate of chlamydia incidence out there (symtomatic and asymptomatic?).

    How does that probability of getting it change
    if you are under 25?
    have more than one partner at a time?
    have multiple partners over time?

    There must be rule-of-thumb epidemiological models that can give some crude estimates of these likelihoods.

    Omitting the absolute risks and relying on fear-mongering and blanket exhortations to patients eventually backfires — patients tune out. We are overloaded and bombarded by too many unquanitified risks, most of which are not relevant to our life situations.

    People need real, relevant probabilities, not relative risks.
    Don’t fear-monger with relative risks.