The Centers for Disease Control and Prevention (CDC) has issued clinical guidelines for using doxycycline as post-exposure prophylaxis after sex to prevent sexually transmitted infections (STIs). DoxyPEP involves taking a single dose of the antibiotic within 72 hours after anal, vaginal or oral sex.

 

The new guidelines are supported by findings from the DoxyPEP trial, which enrolled more than 500 gay and bisexual men and transgender women at public health clinics in San Francisco and Seattle. Taking doxycycline after sex significantly reduced the risk of gonorrhea, chlamydia and syphilis. But this approach failed to lower STI incidence in a similar study of cisgender women in Africa, likely due to poor adherence. Concerns about doxyPEP include antibiotic resistance and its effect on the gut microbiome.

 

The CDC recommends that health care providers should discuss doxyPEP with gay, bisexual and other men who have sex with men and transgender women who have had a bacterial STI within the past year. For other groups, providers are urged to use their clinical judgment and shared decision-making with patients.

 

“Doxy PEP represents the first new STI prevention tool in decades, at a time when innovation in the nation’s fight against STIs is desperately needed,” says Jonathan Mermin, MD, MPH, director of the CDC’s National Center for HIV, Viral Hepatitis, STD and TB Prevention.