New CDC guidelines recommend doxycycline PEP to prevent bacterial STDs

The CDC has finalized new guidelines recommending doxycycline post-exposure prophylaxis (doxy-PEP) for at-risk gay, bisexual, and other men who have sex with men (MSM) and transgender women (TGW) to prevent bacterial sexually transmitted infections (STIs).

Health care providers should discuss and offer doxycycline PEP to people in these groups who have had at least one bacterial sexually transmitted disease (specifically syphilis, chlamydia, or gonorrhea) in the past 12 months, Lindley Barbee, MD, of CDC's National Center for HIV, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention, and her colleagues wrote. Morbidity and Mortality Weekly Report.

“DoxiPEP is the first new STI prevention tool in decades at a time when innovation is desperately needed in the nation's fight against STIs,” Barbee said in a CDC statement.

Recommendations rated AI (strong) are based on the results of four studies: ANRS Aipelgai A study involving MSM and TGW showed that those taking doxyPEP had a reduced risk of chlamydia and syphilis infections by about 70%. However, there was no difference in gonorrhea infections between this group and a non-medicated group. A randomized, open-label trial was conducted in 2022. Doxy PEP TestThe study was conducted in MSM and TGW in San Francisco and Seattle, and in France. ANRS DoxybacA study conducted in MSM showed a significant reduction in the incidence of chlamydia, gonorrhea, and syphilis in the doxyPEP group.

However, in one randomized open-label trial, Doxy-PEP among cisgender women in Kenya It was found that the medication did not prevent sexually transmitted diseases, possibly due to poor compliance.

The guideline authors determined that the potential harms of doxycycline administered at the post-exposure prophylactic dose of 200 mg appear to be generally limited to gastrointestinal side effects.

The guidelines also address concerns about the potential for doxycycline PEP to promote antibiotic resistance against bacterial STDs and other common bacterial pathogens, although it is difficult to draw conclusions from current research. “As these guidelines are implemented, potential risks associated with resistance emergence and microbiome alterations should be monitored,” the authors write.

of The CDC first proposed the recommendation Last October.

Guideline Recommendations

According to the guidelines, 200 mg of DoxyPEP should be taken as soon as possible within 72 hours of oral, vaginal, or anal sex. The dosage should not exceed 200 mg per 24 hours.

Before prescribing doxyPEP, clinicians should advise at-risk people of its potential benefits and harms. People receiving a doxyPEP prescription should also be tested for sexually transmitted diseases at anatomic exposure sites at baseline and every 3 to 6 months thereafter. HIV-negative people eligible for doxyPEP should be screened for HIV at baseline and in accordance with current recommendations. Clinicians should reevaluate the use of doxyPEP every 3 to 6 months.

Doxycycline PEP prescriptions should contain a sufficient dose to last until the patient's next appointment.

Doxycycline PEP should also be prescribed as part of a comprehensive sexual health service that includes risk reduction counseling, screening and treatment for sexually transmitted diseases, and linkage to HIV pre-exposure prophylaxis and HIV care.

The guidelines do not include a recommendation regarding the use of doxycycline PEP for MSM and TGW who have not had a bacterial STI in the past year, but they do note that doxycycline PEP can be discussed with patients in these groups using a shared decision-making approach if they “have not been diagnosed with a bacterial STI in the past year but participate in sexual activities known to increase the chance of acquiring an STI.”

The guidelines also offer no recommendations for cisgender women, cisgender heterosexual men, transgender men, or other queer or nonbinary people who are potentially at risk, for whom the CDC authors commented that there is insufficient evidence to determine benefits and harms.

“Healthcare providers should use clinical judgment and shared decision-making to inform the use of doxycycline PEP in populations not included in CDC recommendations,” the researchers wrote.