The STD 'morning-after' pill? What you need to know about Doxipep — and who can get it

Doctors working to curb the spread of syphilis, chlamydia and gonorrhea — and the potential complications if left untreated — are turning to a promising new means of prevention.

This is known as “DoxyPEP,” which stands for Doxycycline (antibiotic) Post-Exposure Prophylaxis.

Some people liken it to “emergency contraception” because it is taken when there is a risk of contracting a sexually transmitted disease through sexual intercourse.

For Dustin Hatton Alcorn, a 33-year-old gay man from Abbotsford, British Columbia, keeping Doxipep on hand gives him the peace of mind of knowing he has an extra tool to protect his sexual health.

“[It] “It's about being a responsible adult, especially in the queer community,” he told CBC News.

The effectiveness of DoxyPEP has been studied in people at high risk for sexually transmitted diseases: two-spirit, gay, bisexual, and queer cisgender men and transgender women. A small but growing number of studies have shown that in these groups, DoxyPEP significantly reduces the risk of contracting syphilis, chlamydia, and, to a lesser extent, gonorrhea.

However, access to doxipep is limited by place of residence, and it is not a federally approved treatment, which can create additional barriers to availability and awareness.

DoxyPEP is not for everyone and is not a silver bullet

Doxycycline is a commonly used antibiotic that health care professionals may prescribe to treat bacterial infections such as syphilis and chlamydia, conditions such as acne and rosacea, and to prevent malaria. It has minimal potential side effects such as stomach upset and sun sensitivity.

DoxyPEP is similar to an HIV prevention method called PrEP (pre-exposure prophylaxis), in which 2SGBTQ+ people at risk of HIV infection take antiretroviral medication daily.

When taken as prescribed, PrEP has been proven highly effective in reducing the risk of sexually transmitted HIV infection. Virtually eliminated The risk of becoming infected with the virus that causes AIDS.

The 200-milligram dose of DoxyPEP is best taken within 24 hours, but no later than 72 hours, after condomless oral or anal sex.

Dr. Peter Phillips, an infectious disease specialist and member of the BC Centre for AIDS Research's (BC-CfE) DoxyPEP program, said there is compelling evidence that it is effective in preventing sexually transmitted bacterial infections.

Phillips said three randomized controlled trials have found that taking doxycycline after exposure can reduce the risk of contracting syphilis or chlamydia by more than 70 percent, including a study conducted in California, the first state in North America to implement guidelines on doxy-PEP.

While it was less effective at preventing gonorrhea infection, it still reduced the risk by about 50 percent, he said.

But he said there is no conclusive evidence that doxipep provides any benefit to cisgender women, people assigned female at birth or transgender men. study A study conducted in Kenya found no benefits for cisgender women.

Those most at risk are eligible for DoxyPEP

Although the number of cases and the rate of infection with syphilis are lower than those of chlamydia and gonorrhea, if not treated early it can lead to serious complications and affect organ function, Phillips said.

Other preventative measures such as condoms, sex education, testing and contact tracing have not been enough to slow the spread of syphilis, he said.

In December, BC-CfE, with support from the BC government, began offering DoxyPEP free of charge to eligible patients, the first such program in Canada.

In order to meet the standardEligible individuals are those who are enrolled in BC-CfE’s PrEP program for HIV prevention or who are HIV positive and taking antiretroviral therapy medications to stay healthy and reduce the risk of infection.

They must also have had chlamydia, gonorrhea or syphilis within the past year or be assessed as being at clinically high risk.

Phillips said 2,300 people are already enrolled in BC-CfE's DoxyPEP program, and that number is growing by about 300 each month.

Phillips said it's too early to draw definitive conclusions about the program's success because it's only been up and running for less than a year, but he said there's no reason why British Columbia can't achieve similar success as California and other provinces.

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Canadian study underway

PHAC confirmed to CBC News that it is reviewing published evidence to “support the development of recommendations” on DoxyPEP, but did not provide a timeline.

The US Centers for Disease Control and Prevention released the final version. Clinical Guidance I took DoxyPEP in June.

But Drew Schnobe, a pharmacist and team lead at the PrEP Clinic, a private online service launched in Ontario in 2019 to improve access to HIV PrEP, and now DoxyPEP, says the existing data on DoxyPEP is enough to outweigh any hesitation about prescribing it.

“We have the information, we already have real-world experience, and we don't want to hide something that people could benefit from,” he said.

Health Canada also does not approve doxycycline as a preventative treatment for sexually transmitted diseases, but the ministry told CBC News it has not received any proposals to specifically consider doxy-PEP.

Dr. Kaylee Szkarek, an internist, said that's unlikely to happen because doxycycline is a generic drug that's already approved for widespread use.

“Nobody is going to pay the application fee to get that label.”

As a result, DoxyPEP is prescribed off-label, meaning it is used for conditions other than those the drug was originally approved to treat.

“Many medications are being used off-label because there is clinical evidence to support it,” said Szkarek, who is chief medical officer at Calgary-based PurposeMed, which runs Freddy, a private virtual provider that fills prescriptions for HIV PrEP and doxipep.

And efforts are being made to further expand that research, he said.

Szkarek is part of a Canadian research team conducting an open-label, randomized controlled trial. study The study, which involved 560 participants across multiple locations, is known as Doxycycline as an Intervention for Chemoprevention of Bacterial Sexually Transmitted Infections, or DISCO for short.

Participants will be randomly assigned to take either DoxyPEP or DoxyPReP.

DoxyPrEP is a medication in which doxycycline is taken daily, rather than only after sexual activity. It is not currently offered as a treatment for sexually transmitted diseases.

Access Restrictions

Despite the evidence supporting its use, some local health-care providers and sexual health clinics may not offer Doxipep until there is federal approval or guidance, warned Chris Aucoin, executive director of the Health Equity Alliance of Nova Scotia (HEAL NS), formerly known as the AIDS Coalition.

“We just don't have the infrastructure to say, 'This is the way it is,'” he said of the situation in the province, noting that access to PrEP for HIV is limited and testing for sexually transmitted diseases is not widely available outside Halifax.

He says that while they may be able to see a doctor, virtual services like Freddy or PrEP clinics are not an option.

PrEP clinics only operate in Ontario. Freddie only serves British Columbia, Alberta, Saskatchewan, Manitoba and Ontario, and can't expand to some provinces, like Nova Scotia, due to jurisdictional issues, Szkalek explained.

Hatton-Alcorn said even people who live in places with easy access may have trouble finding out about DoxyPEP.

Living 70 kilometres from downtown Vancouver, he switched to using Freddie for HIV PrEP rather than continuing with the BC-CfE program because arranging regular STI tests and prescription pickup became too much of a hassle.

He said he would not have known DoxyPEP was available to him if he hadn't been notified when he renewed his HIV PrEP prescription about six months ago.

“But this isn't just about giving access to medicines. It's about giving access to medical resources and education,” he said.

“And contrary to popular belief, there are queer people who live outside of downtown Vancouver.”

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