Over the past decade, a daily medication known as PrEP (pre-exposure prophylaxis) has allowed people to have unprotected sex while keeping their risk of contracting HIV low. However, they were still susceptible to bacterial bugs. recent spikes Until now in syphilis, gonorrhea and chlamydia.
Recent research show The antibiotic doxycycline, taken after sexual contact, acts as a post-exposure prophylaxis to prevent those infections. But experts also worry about unintended consequences. The Centers for Disease Control and Prevention plans to release guidelines for introducing this treatment later this summer. Doxie PEPIt hopes to address health professionals’ concerns that prophylactic use promotes antibiotic resistance, leading to an increase in drug-resistant super-strength bacteria.
“This is the first large-scale intervention against sexually transmitted infections since the human papillomavirus vaccine nearly 20 years ago,” said Jonathan Mermin, director of sexually transmitted disease prevention at the CDC. “But this is a new intervention, so there are potential benefits and potential risks.”
Physicians, public health officials, and sexual health clinics are embracing prophylaxis as a viable way to control sexually transmitted infections. Because preventative medicine can keep pleasure while protecting your partner. Some doctors have started prescribing it to a narrow segment of the gay community who are considered at high risk for sexually transmitted infections.
“Just as PrEP has been a game changer, it allows individuals to make choices about their sexual health,” said senior Jorge Roman. Director of Clinical Services for the San Francisco AIDS Foundation and one of the first to widely distribute DoxyPEP. “It doesn’t necessarily have to be about condoms.”
Doxycycline is already used as a first-line antibiotic treatment for chlamydia and, in some cases, for syphilis and gonorrhea. However, its prophylactic use has raised concerns that it may become ineffective in patients who use it regularly. It may facilitate the evolution of antibiotic-resistant strains of pathogens.
Proponents of the drug say these concerns are exaggerated. That’s because the criteria are often narrow, such as only men who have sex with transgender women and men, had sex without a condom, and were infected with a sexually transmitted disease in the previous year.
Those layers were adopted be study DoxyPEP was found to be effective in 500 patients in San Francisco and Seattle. The study found that between 2019 and 2022, the number of syphilis, gonorrhea and chlamydia infections among patients who used antibiotics decreased by about 65 percent, mirroring similar results obtained in European studies.
another study DoxyPEP use by cisgender women in Kenya from 2020 to 2022 Resulting in no effect of treatment The researchers were amazed and puzzled.Anatomical differences may play a role, health officials say Other research It has been suggested that doxycycline concentrates sufficiently in vaginal fluids to confer protection against sexually transmitted infections.
Experts say it’s too early to conclude that DoxyPEP has no effect in women, and more research is needed. Another possible explanation is that women enrolled in the Kenyan study may not have used doxycycline consistently after intercourse. The researchers point out that early studies that found that PrEP was ineffective in protecting African women from HIV were ultimately explained by poor adherence to regimens rather than biological differences.
Researchers studying DoxyPEP are scrutinizing whether DoxyPEP could: Antibiotic treatment becomes less effective. In a US study, slight increase Antimicrobial resistance deserves long-term attention, the study authors say. But they also said the finding should be tempered by the fact that doctors would prescribe less antibiotics if people avoided contracting and spreading sexually transmitted diseases.
Directed by David Hyung antibiotic resistance project Dr. Pew Charitable Trust said he was concerned that patients in the study were using DoxyPEP as often as 20 times a month. More data is needed to understand the long-term effects, not just on individuals but on the wider community, he said.
“Continued exposure of patients to antibiotics like doxycycline increases the risk that the patient will become colonized or infected with resistant strains in the future,” Hyung said.
Some LGBTQ+ health care providers suspect doctors are using concerns about antibiotic resistance to mask the discomfort of condomless gay sex. They note that syphilis has not yet acquired penicillin resistance since antibiotics became the frontline treatment for sexually transmitted infections in the 1940s.And they point out that doxycycline is widely used for other reasonssuch as long-term acne treatment and malaria prevention.
“We’ve used doxycycline for multiple other purposes,” Sheila Heisler, medical director of the Detroit Public Health Sexually Transmitted Diseases Clinic, said at the National Coalition of Venereal Officers’ May meeting. “And now, especially when it comes to sexually transmitted infections, I think it’s a good time to say, ‘This is stigma.’
DoxyPEP proponents said it offers a long-needed solution to the surge in sexually transmitted infections. The CDC recorded that the number of people infected with syphilis, gonorrhea and chlamydia will exceed 2.5 million in 2021, up from 1.8 million in 2011.
By 2021, 36% of syphilis and gonorrhea cases will be For men who have sex with men, According to the CDC. The CDC says these disparities cannot be explained by differences in sexual behavior alone. If the population of potential sexual partners with high prevalence of sexually transmitted diseases is small, people are more likely to have sex with someone who has an infectious disease. Cases among cisgender women and heterosexual men are also increasing.
Experts say everyone would benefit from limiting DoxyPEP use to those most at risk, as it would break the chain of infection earlier and reduce the likelihood of more widespread infection.
Some doctors say that making people feel safe to have sex is a worthy goal in itself.
“My goal as a doctor is to allow my patients to have as much and as safely as possible any type of sex they want,” said Bogma Kavisen Titanzi, an infectious disease specialist in Atlanta. “And if DoxyPEP allows it, I have no problem providing it.”
Nick, 35, of Lafayette, Indiana, said he recently started taking Doxy PEP for peace of mind, believing he was less likely to catch an infection because he often had sex without a condom.
Nick said he was no longer worried about HIV after taking PrEP for 10 years. She did so on the condition that she not use her surname to talk openly about her sex life. But he has endured nasty bouts of syphilis and chlamydia.
“If you’re on HIV PrEP, why not take another extra precaution?” he said. “It’s like a security blanket.”
As countries consider how widely to distribute DoxyPEP, public health officials and activists fear it could be the latest medical advancement to be deployed in an unfair manner, given the same racial disparities seen with PrEP and mpox vaccination.Federal officials say even PrEP users are disproportionately white Most new HIV-infected people Black people and Latinos. of CDC estimates Most of the mpox cases occur in black and Latino men, who were given only one-third of the vaccine dose, he said.
LGBTQ+ providers are already reporting disparities, white patients are more likely to ask about DoxyPEP, and black and Latino patients are more likely to be unfamiliar with DoxyPEP.
During a discussion of doxycycline at an STD conference, one state health official noted that doxycycline is available commercially in Mexico, so those who can afford to travel to Puerto Vallarta, a popular vacation destination among some gay Americans, can buy doxycycline and stockpile it for themselves and friends. But experts say concerns about antibiotic resistance will make it difficult to sell it over the counter in the United States.
CDC official Marmin said equity is a top concern as the CDC develops guidance on the use of DoxyPEP. Ensuring the availability of the drug in clinics that see people most at risk for sexually transmitted infections, and raising awareness outside medical settings, such as on dating apps, are essential, he said.
In London, Joey Knock said he started buying Doing DoxyPEP outside of official channels is a common practice among some homosexual Europeans, last winter After regular gonorrhea attacks.
However, he limits its use to high-risk nights, such as unprotected nights. Sex with a stranger in a dark room.
“I’m someone who averages an STD a month,” said 33-year-old Nok. “I did a risk analysis for me, but if taking DoxyPEP means you don’t get chlamydia, then other people will benefit too, so you won’t be passing chlamydia around.”
In San Francisco, the public health agency became the first major jurisdiction. Recommended DoxyPEPhealth workers found patients took a similar approach: using it after high-risk sexual contact rather than after every sexual contact.
“Further analysis needs to be done to see if that could be making DoxyPEP less effective or if people are really making the right decisions about when to use it,” said Stephanie Cohen, head of STD prevention at the San Francisco Public Health Department.
The San Francisco AIDS Foundation, which says it has linked more than 1,800 people to DoxyPEP, doesn’t limit antibiotic administration to people who have recently had a sexually transmitted infection, but advises patients about the unknown risk of antibiotic resistance.
Anu Hazra, comedy director at Howard Brown Health, an LGBTQ+ medical institution in Chicago, said antimicrobial resistance is “probably the biggest public health threat we have,” but the impact of doxycycline on a minority of people pales in comparison to the antibiotic epidemic in the meat industry and other sectors.
Vaccines to prevent sexually transmitted diseases could be another game changer that doesn’t have the same problems as antibiotics, he and other experts say.a Recent research This is encouraging, as it shows that a meningitis vaccine can also reduce the chance of contracting gonorrhea. But DoxyPEP delivers instantly. solutions to ongoing problems and Hazra said it could reduce infections if antibiotic resistance emerges.
“Over the past decade, we’ve seen an overall rise in the prevalence of sexually transmitted infections. What we’re doing now doesn’t work,” Hazra said. “I need to try something new.”