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.

That’s the good news.

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.

The antibiotic doxycycline is used for DoxyPEP treatment
(Photo: Shutterstock)

“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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