Purpose Of Review: Doxycycline post-exposure prophylaxis (doxy PEP) has proven to be highly effective in reducing the incidence of sexually transmitted infections (STIs) among men who have sex with men (MSM) and transgender women. In response, the US Centers for Disease Control and Prevention (CDC) issued official clinical guidance on the use of doxy PEP as a preventive intervention in these populations. However, despite strong evidence supporting its use, the potential risks of antimicrobial resistance (AMR) along with its limited accessibility in other key populations, remain significant concerns with doxy PEP.
Recent Findings: Real-world data show strong awareness, interest, and usage of doxy PEP among MSM and transwomen. Early ecological studies have revealed population-level reductions in chlamydia and early syphilis incidence following doxy PEP implementation. Ongoing research continues to explore its efficacy in other populations, as well as its impact on both individual and population-level AMR. Doxy PEP is a well-tolerated and inexpensive intervention that has the potential to substantially reduce bacterial STIs, particularly in priority populations. Its implementation will require careful assessment of equitable uptake, usage patterns, and long-term monitoring of STI incidence and AMR.
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Development and Evaluation of a Novel Algorithm to Identify Doxy-PEP Users at a Large Healthcare System in the Bronx, New York.
Clin Infect Dis
March 2025
Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, United States.
Doxy-PEP is used to prevent chlamydia, syphilis and gonorrhea infections in sexual and gender minority men and transgender women. We describe a systematic process for developing algorithms that allow for the identification of doxy-PEP prescriptions. Using an identified algorithm will allow for improved monitoring of implementation and effectiveness.
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Sex Transm Dis
April 2025
Division of Infectious Disease, Irving Medical Center, Columbia University.
Background: Three randomized controlled trials have demonstrated the efficacy of doxycycline for bacterial sexually transmitted infection postexposure prophylaxis (Doxy PEP). Few studies have assessed provider knowledge, attitudes, and practices (KAP) regarding Doxy PEP implementation. Between July of 2023 and January 2024, this study qualitatively assessed KAP and intention to prescribe Doxy PEP among health care providers in the New York City area.
View Article and Find Full Text PDFPotential Impact of Doxycycline Post-Exposure Prophylaxis on Tetracycline Resistance in Neisseria gonorrhoeae and Colonization with Tetracycline-Resistant Staphylococcus aureus and Group A Streptococcus.
Clin Infect Dis
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Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA.
Background: Doxycycline post-exposure prophylaxis (doxy PEP) is increasingly used among men who have sex with men (MSM). Its impact on antimicrobial resistance and the microbiome is uncertain.
Methods: We used Neisseria gonorrhoeae (NG) surveillance data from King County, WA and joinpoint regression to investigate trends in NG-tetracycline resistance (tetR), 2017-2024 and, among sexual health clinic (SHC) patients, evaluated the association of NG-tetR with doxy PEP use.
Antimicrobial susceptibility of commensal Neisseria species in the Japanese population.
J Infect Chemother
February 2025
Department of Infection Control and Prevention, Faculty of Nursing, Toho University, 4-16-20, Omori-nishi, Ota-ku, Tokyo, 143-0015, Japan.
Objectives: We aimed to, for the first time, characterize the antimicrobial susceptibilities of commensal Neisseria species in the general population in Japan. In particular, we assessed if the tetracycline minimum inhibitory concentrations (MICs) of these isolates were changing over time and, given the recent interest in doxycycline post exposure prophylaxis (PEP), if the tetracycline MICs were associated with those of the other antimicrobials.
Methods: Neisseria spp.
Promises, Pitfalls, and Progress: Doxycycline Prophylaxis for Bacterial Sexually Transmitted Infections.
Curr HIV/AIDS Rep
February 2025
Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, 5841 S. Maryland Avenue, MC5065, Chicago, IL, 60637, USA.
Purpose Of Review: Doxycycline post-exposure prophylaxis (doxy PEP) has proven to be highly effective in reducing the incidence of sexually transmitted infections (STIs) among men who have sex with men (MSM) and transgender women. In response, the US Centers for Disease Control and Prevention (CDC) issued official clinical guidance on the use of doxy PEP as a preventive intervention in these populations. However, despite strong evidence supporting its use, the potential risks of antimicrobial resistance (AMR) along with its limited accessibility in other key populations, remain significant concerns with doxy PEP.
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