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The Centers for Disease Control and Prevention (CDC) this week released new clinical guidelines on the use of doxycycline postexposure prophylaxis (doxy PEP) for bacterial sexually transmitted infection prevention. In part, CDC’s recommendations include the use of doxy PEP for gay, bisexual, and other men who have sex with men (MSM) and transgender women (TGW) who have had a bacterial sexually transmitted infections diagnosed in the past 12 months as part of provider shared decision-making. Prescribed doxy PEP can be self-administered within 72 hours after having oral, vaginal, or anal sex with a recommended dose of 200 mg per 24 hours. Further, the agency encourages providers to use clinical judgement and shared decision-making when considering doxy PEP with populations that are not part of the recommendations because of the lack of research on effectiveness.

With some caution: Three clinical trials of doxy PEP that looked at adverse events found gastrointestinal side effects were the most commonly reported. However, CDC noted “There are no studies to date on long-term, intermittent use of doxycycline and the microbiome. Current data suggest overall benefit of the use of doxy PEP, but potential risks related to the development of resistance and changes in the microbiome will need to be monitored as these guidelines are implemented.”

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