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A study published in the Journal of Antimicrobial Chemotherapy analyzed data from men who have sex with men who were either living with HIV or using HIV pre-exposure prophylaxis. The researchers found that using doxycycline post-exposure prophylaxis (doxyPEP) after unprotected sex significantly reduced the need for antibiotics to treat bacterial sexually transmitted infections (STIs). Between August 2022 and July 2024, 754 men in Italy were prescribed doxyPEP, and 222 (29.4%) reported using it during follow-up. Among those users, bacterial STIs dropped from 401 cases before doxyPEP to 146 after. Also, days of therapy per 1,000 patient-days fell to 1.26 for ceftriaxone (gonorrhea), 0.37 for benzylpenicillin (syphilis), and 3.21 for doxycycline (chlamydia). Without doxyPEP, expected days of therapy would be: 4.85 for ceftriaxone; 1.86 for benzylpenicillin; and 24.71 for doxycycline. Although there are concerns that doxyPEP might drive antibiotic resistance, the study suggests that targeting high-risk individuals may lower overall antibiotic use, according to the authors.
Prevention recommendations: The Centers for Disease Control and Prevention recommends that men who have sex with men and transgender women who have had a bacterial STI (specifically syphilis, chlamydia, or gonorrhea) diagnosed in the past 12 months should receive counseling that doxyPEP can be used as postexposure prophylaxis to prevent these infections.
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