With rising rates of sexually transmitted infections (STIs) in the US, a new strategy has emerged in the reduction of STIs—particularly in men who have sex with men (MSM), and transgender women (TGW): DoxyPEP.
What is DoxyPEP?
Doxycycline Post-Exposure Prophylaxis (DoxyPEP), is the process of taking the antibiotic doxycycline after sex to reduce the transmission of bacterial STIs like chlamydia, gonorrhea, and syphilis. In fact, rates of syphilis and chlamydia infections were halved among men who have sex with men and transgender women in San Francisco a year after the city introduced DoxyPEP.
Doxycycline is not a new medication, but this particular use of it to prevent bacterial STIs is. Doxycycline has been used to treat a variety of infections caused by bacteria, as well as acne and rosacea. It has been used as a common antibiotic due to its low cost, safety and mild potential side effects.
DoxyPEP treatment is not 100% protective, but studies have shown that it can decrease the likelihood of contracting syphilis, chlamydia, and gonorrhea by about 60%.
DoxyPEP does not help prevent HIV, mpox (monkeypox), or other viral infections.
Who Can Take Doxycycline for DoxyPEP?
DoxyPEP is recommended for cisgender men who have sex with cisgender men and transgender women with cis men or transgender female sexual partners, have had condomless sex with more than one partner in the past year, and have had a bacterial STI in the past year.
Current studies support the implementation of DoxyPEP only in gay and bisexual cis men, and transgender women. There have been no studies of DoxyPEP in cisgender women.
How Do You Get Doxycycline for DoxyPEP?
First, make sure you’re eligible to take doxycycline for DoxyPEP. Then, schedule a routine primary care visit with a health care provider, and let them know that you’re interested in DoxyPEP.
The provider will do STI testing and basic blood work to confirm your eligibility, and once your results come back and eligibility is confirmed, you’ll get a prescription. The doxycycline and your visit should be covered by insurance. If you don’t have health insurance, the San Francisco AIDS Foundation has outlined a step-by-step guide for getting discount doxycycline for DoxyPEP through GoodRx.
When Should You Take Doxycycline for DoxyPEP?
Patients are advised to take two 100 mg doses of doxycycline within 24 hours, but no later than 72 hours after condomless sex—which means oral, anal or vaginal/front-hole sex where a condom was not used for the entire time. Doxycycline is a pill that should be taken with water, and if it makes your stomach upset you can take it with food. You could take doxycycline every day if you are having condomless sex, but don’t take more than 200 mg every 24 hours.
Can I Take PrEP and DoxyPEP At The Same Time?
Yes, it’s safe to take PrEP for HIV and DoxyPEP concurrently.
Are There Side Effects of Doxycycline for DoxyPEP?
Common side effects of doxycycline include diarrhea, itchiness and skin sensitivity. Some people are more sensitive to the sun when they take doxycycline, so it’s important to wear sunscreen and/or stay covered when spending extended time outside.
What Else Should I Know About DoxyPEP?
It’s important to get tested for STIs before starting DoxyPEP treatment, and every three months after starting the treatment.
Because the use of doxycycline for DoxyPEP is relatively new, researchers are still learning about the effects of DoxyPEP treatment on “good” gut bacteria, the bacteria that live on the skin, and possible resistance to STIs.
Doxycycline has a long safety history when used for extended periods of time, but studies regarding antibiotic resistance are still ongoing. The current limited data suggests that DoxyPEP does not significantly increase antibiotic resistance in people who take it, but medical organizations like the CDC are continuing to monitor results.
Conclusion
DoxyPEP treatment is a major innovation in the prevention of STI transmission, and is an effective way to reduce the risk of transmitting chlamydia, syphilis and gonorrhea in men who have sex with men, and transgender women. However, it does not reduce the risk of other infections like HIV or mpox. Doxycycline is generally safe to take, but there can be mild side effects like an upset stomach.
