Doxycycline post-exposure prophylaxis as prevention of STIs – the golden bullet?
No Thumbnail Available
Authors
Kohli, Manik
Elliott-Walker, Thomas
Saunders, John
Fifer, Helen
Check for full-text access
Issue Date
25/05/2025
Type
Journal Article
Language
Keywords
Sexually transmetted diseases
Alternative Title
Abstract
Introduction Doxycycline post-exposure prophylaxis (‘doxyPEP’) is an emerging strategy to prevent bacterial sexually transmitted infections (STIs). Users take 200mg of doxycycline up to 72 hours after condomless sex, and data from randomized controlled trials and real-world implementation have shown doxyPEP to be effective in preventing syphilis, chlamydia, and to a lesser extent gonorrhea, in gay, bisexual, and other men-who-have-sex-with-men (GBMSM) and transgender women. Areas covered: We discuss the potential benefits, risks, and important considerations for doxyPEP implementation, drawing on published literature and our own perspectives. Expert opinion: Is doxyPEP the golden bullet? DoxyPEP provides significant benefits through STI prevention and holistic improvements in sexual health and wellbeing. Concerns over emergent antimicrobial resistance need to be weighed against STI-related morbidity and contextualized within society’s overuse of antibiotics. Inequities in the doxyPEP evidence-base and implementation will undermine its ability to end the syphilis epidemic and reduce chlamydia associated morbidity in cisgender women. Moreover, contexts in which doxyPEP proves effective for gonorrhea prevention initially are unlikely to see a long-lasting impact. Rather than a golden bullet, doxyPEP is a bridge to the next set of STI prevention tools.
Description
Citation
Expert Review of Anti-infective Therapy. 2025; 53(7):445-457
Publisher
License
Journal
Expert Review of Anti-infective Therapy
Volume
23.0
Issue
7.0