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Two studies show that Doxy PEP is a winning strategy
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Two studies published this month JAMA Internal Medicine offer encouraging findings regarding the use of Doxy PEP. A study in San Francisco found lower rates of syphilis and chlamydia after doxy PEP was introduced than expected. Another study in Northern California found fewer cases of chlamydia, syphilis, and gonorrhea among PrEP users who also used doxy PEP. Although there isn’t enough data yet to prove a direct causal link, the authors of both studies believe that the early PEP vaccine circulating in parts of California is behind the decline in STD rates in the state.
Doxy PEP is a new STD prevention strategy. Users take the antibiotic doxycycline after oral or anal sex without a condom to prevent chlamydia, gonorrhea, or syphilis. Early studies showed that it can reduce the risk of syphilis and chlamydia by 80% or more. It can also reduce the risk of gonorrhea by 50% when used by men who have sex with men (MSM) and trans women who have sex with men. Research on cisgender women who have sex with a penis in the vagina did not find doxy PEP to be effective.
San Francisco was an early adopter of this strategy. One of the new studies looked at the rates of bacterial STDs in that city after the introduction of doxy PEP. Compare these numbers to predicted rates based on past data. The researchers looked at actual and predicted numbers over a 13-month period ending in November 2023. They found that chlamydia fell by 50% compared to predictions, and early syphilis fell by 51%. Gonorrhea cases, however, were higher than predicted rates for that period.
THE another study was conducted among patients with Kaiser Permanente in Northern California. It included 11,551 people taking PrEP to prevent HIV. The researchers found that those who also received doxy PEP had fewer cases of all bacterial STDs. Specifically, quarterly positive tests dropped by 79% for chlamydia, 80% for syphilis and 12% for gonorrhea. In contrast, rates of these STIs remained stable among participants who took PrEP but did not use doxy PEP.
The researchers observed that the reduction in gonorrhea cases only included infections of the urethra or anus. There was no reduction in cases of gonorrhea of the throat. More research is needed to understand why doxy PEP is ineffective against throat infection.
There are concerns about antibiotic resistance and whether the widespread use of doxy PEP could add to the problem. The bacteria that cause gonorrhea, for example, have already shown resistance to entire classes of antibiotics. In fact, existing resistance to doxycycline may be the reason doxy PEP is not as effective against gonorrhea. The fear is that increasing the use of doxycycline will give bacteria more opportunities to develop antibiotic resistance. The authors of both studies agree that this issue needs to be investigated further.
The Centers for Disease Control and Prevention (CDC) offers guidelines for the use of Doxy PEP. The CDC recommends that providers discuss doxy PEP with men who have sex with men and transgender women who have sex with men—especially those who have had an STD in the past year.
These new studies provide a glimpse into how doxy PEP use among MSM and trans women could positively impact population-wide STD rates.
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