This major US city rolled out DoxyPEP to gay men & here’s what happened to STI rates

A new study has reported on the impact of DoxyPEP in San Francisco. The California city, with its high proportion of gay men, has been among the first to recommend prescribing DoxyPEP to high-risk communities.

DoxyPEP is short for Doxycycline Post-Exposure Prophylaxis. It involves taking a single, 200 mg dose of the antibiotic doxycycline within 72 hours of a sexual encounter to minimize the chances of acquiring an STI such as gonorrhea, chlamydia or syphilis.

San Francisco began allowing health providers to distribute the antibiotic for this purpose in late 2022. It advised giving the medication to gay men who have multiple partners, and to trans women.

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Around 40% of people taking PrEP in the city have now also tried DoxyPEP. Organizations say they’ve been encouraged by the large number of gay men who want to take it.

Last October, the CDC issued its first official guidelines regarding DoxyPEP. It gave the treatment its approval. The organization is exploring all means necessary to try and reduce soaring STI rates in the US. Experts had been holding off as there are concerns around over-prescribing antibiotics. However, trials have found little evidence of DoxyPEP increasing resistance in the bacteria it targets.

That said, the CDC guidelines were a little less liberal than those in San Francisco. It recommended DoxyPEP as an option for gay men and trans women who have had a positive STI diagnosis in the past year. You don’t need an STI diagnosis to get DoxyPEP in San Francisco.

Fifty-eight per cent decrease in STIs

This week, at the Conference on Retroviruses and Opportunistic Infections (CROI 2024), researchers presented results from SF.

They say that in the year after the city began prescribing DoxyPEP cases of chlamydia dropped steeply. Syphilis cases also dropped significantly. However, there was only a slight drop in gonorrhea, reports aidsmap. Overall, there was a 58% decrease in STIs for those taking DoxyPEP.

That’s good news and encouraging to those concerned about the nation’s sexual health.

Experts welcomed the real-world results alongside further trial data.

“It’s not often in public health that you have population-level surveillance in concordance with clinical service delivery in concordance with clinical trial results, all at the same time,” CROI chair Professor Landon Myer of the University of Cape Town said at a media briefing. “This, to my mind, seals the case.”

Besides the results from San Francisco, the conference heard results from a trial in France. Last year, that study reported a 70% reduction in STIs in gay men on DoxyPEP. That trial was extended. The trial was unblinded. In other words, the participants were told if they’d been prescribed DoxyPEP or a placebo. They were then all offered DoxyPEP if they wanted it.

Many men did indeed want to take the medication. That group showed a similarly steep drop in STIs to that seen in San Francisco.

In contrast, a study in Kenya was unable to repeat the results in young, cisgender women. Syphilis is rare among this group in this part of the world. However, the DoxyPEP did not reduce chlamydia levels. It’s unclear why.

It’s also unknown why DoxyPEP is less effective at reducing gonorrhea. One suggestion is that DoxyPEP needs to be taken sooner after sex. However, more research is needed to find out if this is the case.

Exciting new tool

Jorge Roman is the Senior Director of Clinical Services at the San Francisco AIDS Foundation. It has been prescribing DoxyPEP since late 2022. He welcomed the study results.

“We are noticing an impact of Doxy PEP on reducing sexually transmitted infections,” Roman said in a statement.

“For so long, we have only been able to rely on condoms for STI prevention–and we know that condoms don’t work for everyone. There is a clear need for additional strategies to reduce STI rates–in San Francisco, and across the U.S., the number of cases of chlamydia, syphilis, and gonorrhea have been on the rise for many years. It is exciting to have a new tool that we can make available for STI prevention.”

Related:

DoxyPEP, a.k.a. the “gay morning after pill”, set to receive CDC stamp-of-approval in preventing STIs

The antibiotic has been highly effective in preventing STIs like chlamydia and gonorrhea.

Good & bad news from the CDC about sexually transmitted disease rates

Gonorrhea rates fell for the first time in ten years – but a more dangerous infection is on the increase