DoxyPEP has hit the news following a sexual health conference last weekend. Attendees at the Conference on Retroviruses and Opportunistic Infections in Seattle heard the results of several new studies into the treatment.
DoxyPEP is short for Doxycycline Post-Exposure Prophylaxis. It means taking the antibiotic doxycycline after a sexual encounter to minimize the chances of acquiring an STI such as gonorrhea or syphilis. Doctors are exploring it as one way to tackle the soaring STI rates in the US.
A study last year found that when used within three days after unprotected sex, doxycycline reduces STIs by more than 60% in gay men.
The latest study took place in France and involved 500 gay and bisexual men. It found doxycycline lowered the rates of gonorrhea, chlamydia and syphilis by 51% to 89% when taken within 72 hours of sex.
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On the flip side, scientists have been warning for decades not to overprescribe antibiotics. They fear it might lead to the development of antibiotic superbugs. This makes the use of DoxyPEP controversial. Many experts remain undecided on the issue.
Effective in gay men but not cis women
The Seattle conference heard the results of another study. It found no marked increase in doxycycline resistance among three key bacteria, including gonorrhea and staph. Of course, that doesn’t rule out resistance developing in the future.
Although slashing STIs in gay guys, the Seattle conference also heard that a trial in Kenyan women found no reduction in STI rates with DoxyPEP. That study’s author, Dr. Jenell Stewart of the University of Minnesota, called that result “very disappointing.” Stewart said it could be down to differences in anatomy, antibiotic resistance and adherence to the medication.
Last October, San Francisco became the first city in the US to issue guidelines on the use of DoxyPEP.
Jorge Roman is the senior director of clinical services at the San Francisco AIDS Foundation. He tells Queerty, “We’ve been able to incorporate Doxy PEP services into the flow of our clinic, and have found that the majority of our clients have been interested in adopting this strategy once they have more information about it. At this time, we have more than 800 clients who have been prescribed Doxy PEP.”
Should more guys be on DoxyPEP?
It’s no secret that condom use has fallen in recent years. So, should DoxyPEP be more widely available? Queerty asked some experts in the field their opinion.
Dr. Carlton Thomas has picked up a huge following on TikTok with his no-nonsense advice for queer men.
“There is a risk-benefit ratio that happens with every decision we make about medications,” he tells Queerty.
“I believe anything that drops certain STI rates by such a significant margin should be taken very seriously. Many doctors refuse to offer it now due to fears of fueling antibiotic resistance. Even now on the CDC STI website there is an acknowledgment of DoxyPEP but not a formal recommendation. This needs to be hammered out better.”
@doctorcarlton #gay #bisexual #trans #gaytiktok ♬ original sound – Doctor Carlton
Dr. Leandro Mena, the CDC’s director of STD prevention, told NBC this week that the agency is looking at establishing doxyPEP guidelines. However, it wants to wait for the results of some more studies, due this spring, first.
Related: Meet the gay doctor answering the questions you’re too shy to ask your physician
Some men already getting hold of DoxyPEP
Will Nutland is Co-Director of the UK-based The Love Tank CIC. Through its PrEPster program, it’s helped queer men access PrEP.
“UK-based research that we’ve been part of generating shows that not only is there interest in using antibiotics to prevent STIs in this way, but many gay men already are. As such, our collective response needs to ensure that those doing so are informed, accessing their medication from reliable sources, and are supported in using Doxy PEP and PrEP appropriately.
“Of course, there are global concerns about the overuse of antibiotics,” Nutland acknowledges.
“But this new research, and other recent research, presents us with an opportunity: if those most likely to be exposed to these STIs are offered antibiotics in this way, then the overall incidence of some STIs could be reduced.
“A resulting reduction in STIs could then lead to an overall reduction in the use of antibiotics.”
Call for more federal investment in sexual health
A spokesperson for the National Coalition of STD Directors (NCSDDC) said they welcomed the latest studies.
“We are excited to see the latest news of DoxyPEP’s effectiveness in MSM and trans people. We have an epidemic of STIs in the U.S. and innovations like DoxyPEP are important – but we have an enormous need for dedicated federal investment in STI clinical services to help people get the testing, treatment, and prevention services that are right for their individual needs.”
Should DoxyPrEP be available for all who want it, or just targeted at the people most at risk of STIs?
The spokesperson said, “Everyone should have access to the tools they need, as an individual, to prevent and treat STIs, and we look forward to seeing the STI Treatment Guidelines reflect the growing body of evidence on DoxyPEP.
“That may mean that we’re increasing access for MSM and trans people who want and need DoxyPEP but not for cisgender women if the evidence continues to show it’s not effective for them.”
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Prax07
No amount of money would make me take prep, wouldn’t take this new thing either.
Openminded
Prax, I’m considering getting on Prep and would like to hear your concerns. I’m aware of the possible kidney issues, but aside from that it seems to be fairly non-problematic. Always good to hear other’s opinions.
MDWolf12
I am on prep and love it. My husband is undetectable so it is a extra layer of protection and without any barriers to our intamacy. I also have no side effects.
LumpyPillows
I’ve been taking Truvada – PReP for years and years with no side effects. Regular testing is great to monitor my liver and it is also nice to have the frequent STD/STI testing.
Recently changed to Descoy which is supposed to be even easier on the liver. Turned out with my insurance to also be free.
If you are having sex with men, use PReP.
Openminded
Thanks for the replies.
Luke
First off: PrEP for HIV and Doxy-PEP are two very different things.
But as to Queerty and the main article: I would AGAIN ask Queerty and their contributors to be more responsible. I ask them again: Do not downplay the significance of the medical evidence reviews by emphasizing that “some people are already on it for acne,” or “modest and transient” resistance, while the review studies considered it a troubling trend because of historical precedent in antibiotic resistance, and because of all the chronic illnesses we are increasingly finding are rooted in disruption of the gut microbiome.
The benefits do NOT outweigh the risks.
Doxycycline is one of the ONLY things left in the antibiotic arsenal to treat syphilis in people who are allergic to penicillins. It is folly to hasten the day when we will not be able to treat them with Doxycycline.
It is also absurd to hasten the day when we will not be able to cure gonorrhea, chlamydia, and NSU with antibiotics.
We are at least a decade away from effective vaccines against gonococcus alone. Two novel antibiotics that could be used, zoliflodacin and gepotidacin, are up to three years from approval (and if they are misused, we will be back at square one). The nation is still NOT prepared to set up our clinics for IV infusions of nano-particle silver hydrosol, and none of the crucial dose-escalation trials been set-up to determine the optimal dose for cure using that method of delivering silver. This is not a good place to be for us to be playing with fire by abusing Doxycycline.
I have been beating my head against the wall with the CDC for ELEVEN YEARS to set up those dose-escalation trials for IV infusions of nano-particle silver hydrosol, because the writing was already on the wall MORE than 11 years ago about antibiotic resistance and STIs, when the CDC called it “an urgent threat that requires urgent and aggressive action.” But when I first raised this with them and the SFDPH, they looked at me like I was some pseudoscientific whackjob, until I made them go back and read the damned studies on using silver proteinate (a much less potent, more toxic version of silver) in the Army, from before the sulfonamides were invented in 1935. Once they saw that, then their excuses became: “Our clinics aren’t set up for that; it will cost too much.” Which is exactly what they said about monkeypox vaccines in the beginning.
Since David Holland and the other advocates of the foolishness of Doxy-PEP started promoting it, I have been warning about the gut resistance, and what that would signal. And again calling to prepare with trials of nano-particle silver hydrosol IV delivery. And now, increasingly, the study reviews are bearing out my warnings.
Look, I am not a naysayer about chemoprophylaxis, by any stretch. I was one of the very first community advocates for PrEP and PEP for HIV. And I was LOUD about it. Because I had read the studies thoroughly, after having lost so many friends who wished we could one day have such a thing. I learned to parse medical evidence because I had to. And I helped public health departments and many others get the word out on PrEP and on Treatment as Prevention (TasP).
But here the Doxy-PEP promoters are turning a damned blind eye. And for what? For a transient benefit for a few people in a certain (privileged) class and (primarily white) race that will cost everybody down the line? Please don’t advocate for this; it is irresponsible.
Sten
New? This antibiotic has been around since the early 1960s! It is a broad spectrum antibiotic which has been extensively studied and is quite safe.
It’s used in many areas including Malaria prophylaxis.
winemaker
This is like alcoholics drinking Sharps or O’Douls ( non alcoholic beer for those unfamiliar with these 2 brands) because they like the taste of beer despite these beverages contain trace amounts of alcohol. What ever happened to safe sex and responsibility? Promiscuity has its consequences
Creamsicle
That analogy doesn’t really make sense. The PEP drug isn’t a substitute for sex.
mykelb
Your feelings on promiscuity do not affect the public health. Your feelings do not matter at all. What matters is getting the rates of STI down among MSM and as far as that goal is concerned, it is looking like this drug can greatly assist with that goal.
Kangol2
Your analogy is nonsensical. Also, in 2023 using PEP and PrEP is a crucial form of safe sex, and very responsible. Moreover, your right-wing judgement blazes through when you mention “promiscuity.” One need not be “promiscuous” to seroconvert to HIV+ or to get an STI. One sexual act could result in seroconversion or getting an STI. One. So “promiscuous” sounds like something out of the pre-Stonewall era.
abfab
Life has its consequences, wino…….
Openminded
“Should DoxyPrEP be available for all who want it, or just targeted at the people most at risk of STIs?”
I don’t understand the question here. Isn’t ANYONE who is having unprotected sex with anyone other than monogamous partners “most at risk of STIs”? People in true monogamous relationships aren’t concerned with STIs. It should go without saying that this treatment is not appropriate for “ALL” others.
Creamsicle
Not according doctors and public health guidelines. Any MSM is considered high risk according to public health guidelines. Just because you are faithful in a monogamous relationship doesn’t guarantee that your partner is being perfectly monogamous. Plenty of people, of all orientations, have gotten an infection because they trusted somebody else to adhere perfectly to monogamy and safer sex advice.
This is just one new tool. Nobody is going to force it on you. It’s understandable that medical professionals would be divided on this, considering how quickly antibiotic resistance develops.
But the biggest driver of antibiotic resistance isn’t overprescription of antibiotics in people. It’s prophylactic antibiotic use in livestock to allow them to be packed in as close as possible on industrial feed farms.
bachy
It is increasingly evident that we are entering a new era in which new drugs and new medical procedures will be integral to living what is considered “the good life.”
I have mixed feelings about much of this, but I’ve had mixed feelings about a lot of emerging new ideas I’ve seen these past decades. My “mixed feelings” don’t seem to have any effect on how new cultural developments eventually become canon.
It’s the future and it’s coming for us all, people. Faster and faster.
LumpyPillows
I’d use this new drug. I rarely have sex anymore, but when I do, the fellow is usually a bit or a player.
Anyone casting shame on someone else have lots of sex should really keep that to them selves. Take it from grandpa, be smart but get sex a lot. The day will come when the ride is over.
bachy
see: sildenafil
LumpyPillows
It’s not the ability, it’s finding happy partners. Ageism is real and so many men my age have either let themselves go, or only like younger men whom they “subsidize”. No shade. It just is what it is.
HaguePeter
“On the flip side, scientists have been warning for decades not to overprescribe antibiotics. They fear it might lead to the development of antibiotic superbugs.”
Might lead to?
We know that overprescribing antibiotics renders them useless in decades to come. Overprescribing is selfish.
QJ201
This is simply scientific evidence supporting what gay men have been doing since the 70s.
Same with PreP. Gay men were doing it on their own for over a decade before it was officially recommended and supported by science. Same with U=U. We “knew” this for 2 decades before the “science” was done to prove it.
G-Man
This was taken from the CDC website there is already a drug resistant gonorrhea that has appeared in New York. The only drug that seems to cure it is the same drug they use for Meningitis. So best thing you can do to protect yourself is to practice safe sex, or there will come a day when the drugs just won’t work. With that being said, have fun but just be careful.
Gonorrhea has progressively developed resistance to the antibiotic drugs prescribed to treat it. Following the spread of gonococcal fluoroquinolone resistance, the cephalosporin antibiotics have been the foundation of recommended treatment for gonorrhea. The emergence of cephalosporin-resistant gonorrhea would significantly complicate the ability of providers to treat gonorrhea successfully, since we have few antibiotic options left that are simple, well-studied, well-tolerated and highly effective. It is critical to continuously monitor resistance and encourage research and development of new treatment regimens.