It is not very often that we are able to report on a new breakthrough in sexually transmitted infection/disease treatment or prevention. The first ones were #PEP and #PrEP to halt HIV infection either AFTER exposure or BEFORE condomless anal sex, respectively. They were followed by #U=U regarding the fact that those living with HIV, on effective treatment, cannot pass the virus on to their sexual partners.

We are pleased to share with you information from a new study regarding the medication doxycycline and its ability to prevent STI infections AFTER exposure (PEP).

This is game-changing news that we should all learn more about and share with as many members of our community as possible. In light of recent concerns about #PrEP users increased exposure to other STIs, outside of HIV, having a medication that performs as a post-exposure prophylactic is a great advantage.

What is Doxycycline?

Doxycycline is a broad-spectrum tetracycline-class antibiotic used in the treatment of infections caused by bacteria and certain parasites. It is used to treat bacterial pneumonia, acne, chlamydia infections, Lyme disease, cholera, typhus, and syphilis.

It is also used to prevent malaria in combination with quinine. Doxycycline may be taken by mouth or by injection into a vein.

Like other agents of the tetracycline class, it either slows or kills bacteria by inhibiting protein production.

Common side effects include:

Doxycycline was patented in 1957 and came into commercial use in 1967. It is on the World Health Organization’s List of Essential Medicines. Doxycycline is available as a generic medicine. In 2019, it was the 90th most commonly prescribed medication in the United States, with more than 8 million prescriptions.

What were the research findings?

A US study that provided gay and bisexual men with the antibiotic doxycycline to take after condomless sex was stopped a year early because of its high efficacy, the 24th International AIDS Conference in Montreal was told on the 28th of July, 2022. 

The DoxyPEP study compared the incidence of gonorrhea, chlamydia, and syphilis in 374 people who were given doxycycline to take after sex with the incidence in 180 people who were not provided with the drug. It found that doxycycline cut the risk of STIs by two-thirds.

The study involved 360 HIV-negative people using HIV pre-exposure prophylaxis (PrEP) and 194 HIV-positive people, aged over 17 and born male, attending two clinic sites in Seattle and San Francisco. The other criterion for the study was that they had to have had at least one of the three STIs in the last year.

An interim review of 13 May 2022 found that efficacy was so high it would be unethical to continue with the control arm and all participants were given doxycycline.

Important findings from the study, are:

  • Efficacy in the HIV-negative participants was 66%
  • Efficacy against chlamydia was high, at 79% in HIV-negative people
  • Efficacy was still significant against gonorrhea, at 59% in people without HIV
  • Syphilis, efficacy was 76% in HIV-negative people 
  • Efficacy in the participants with HIV was a bit lower, at 62%, but still significant.
  • Efficacy against chlamydia was 70% in people with HIV
  • Efficacy was still significant against gonorrhea was 57% in people with HIV
  • Syphilis, efficacy was 42% in people with HIV, but the number of infections was small (three versus two in the DoxyPEP and control arms in HIV-positive people), so this lower efficacy in people with HIV may not be significant
  • Adherence to doxycycline was good, with 87% of incidents of condomless sex protected by it
  • More than half of the participants (54%) took fewer than ten PEP doses a month, 39% took 10-20 doses, and 16% took over 20 doses (so almost daily).
  • There were no serious adverse events

“Until now, it has not been certain whether doxycycline would work as post-exposure prophylaxis (taking it after sex – ­­­­PEP). A couple of previous studies have been done, a small one in the US in 2015, and a French study in 2017. But both of these used daily STI pre-exposure prophylaxis (taking it before sex – PrEP).  Furthermore, while both studies cut the incidence of syphilis, the US study had no significant effect on chlamydia and neither had an effect on gonorrhea. In the latter case, this was ascribed to the fact that there are many strains of gonorrhea resistant to doxycycline.”

The efficacy of DoxyPEP now opens up the possibility of its more widespread use as STI prophylaxis. DoxyPEP implies taking the drug less often than for DoxyPrEP, both saving money and reducing concerns about the over-use of antibiotics leading to resistance and side effects. 

Safer Sex Practices

As important as this new study is, so is maintaining a full and complete toolkit for safer sex healthcare. This may range anywhere from serosorting your sexual partners, understanding and believing in the science behind #uequalsU, taking precautions against HIV infection with #PrEP and #PEP as well as using condoms.

Doxycycline is just ONE more component that is on offer. It should not be a total supplement to your entire current sexual healthcare regime.

  • natural/condomless sex has been on the rise within the gay male community for some time and this trend does not seem to be slowing down. With this in mind, being honest about your sexual choices with yourself, your partners and your doctor is important.
  • honesty with a doctor can only happen if you choose the right one for you and your comfort level. Your provider can not assist you in maintaining proper sexual healthcare standards if they do not have a complete picture of your sexual life. They are also less likely to prescribe medications like PrEP for you or schedule regular STI check-ups.
  • knowing your full STI status, not just for HIV is vital information for you and your sexual partners. This information will help you make the most informed decisions about which safer sex practices are best for you and how successful they may be.

Before you go…

Just like the majority of you, we have had our own experiences with contracting an STI, and we hate it each time it happens. Instead of slut shaming, we believe education and freedom to tell the truth to our doctors and sexual partners is the best way to reduce the incidence of infections within our community. Shame helps no one.

If the monkeypox outbreak should teach us anything, it should be that contracting an STI is much more complex than just the exchange of bodily fluids. And, along with bacterial infections, some viruses can easily be spread through intimate touch. Keep this in mind, the next time you or someone you know attempts to use coercion and shaming to stop the spread of STIs because it does not work.

Only compassion, understanding, education, and communication have succeeded. Along with practicing some form of safer sex, sexual healthcare.

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