Doxycycline post-exposure prophylaxis prevents sexually transmitted infections in HIV PrEP users

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Doxycycline post-exposure prophylaxis (doxyPEP) given to people on HIV pre-exposure prophylaxis (PrEP) was shown to reduce chlamydia by 79%, syphilis by 80%, and gonorrhea by 12%.¹

The research results are JAMA Internal Medicine.

“Quarterly chlamydia positivity among doxyPEP recipients decreased from 9.6% (95% CI, 9.0%-10.3%) before doxyPEP initiation to 2.0% (95% CI, 1.5%-2.6%) after doxyPEP initiation (RR, 0.21; 95%) CI, 0.16-0.27; P < .001), with significant decreases by anatomical site of infection. Quarterly gonorrhea positivity rate decreased from 10.2% (95% CI, 9.6%-10.9%) before starting doxyPEP to 9.0% (95% CI, 8.0%-10.1%) after starting doxyPEP (RR, 0.88 ; 95% CI, 0.77-1.00); P= .048); site-specific decline was significant in the rectum (RR, 0.81; 95% CI, 0.67-0.97; P= .02) and urethra (RR, 0.56; 95% CI, 0.40-0.79; P= .001) gonorrhea, but not pharyngeal gonorrhea,” the researchers wrote. “Quarterly syphilis prevalence decreased from 1.7% (95% CI, 1.4% to 1.9%) before starting doxyPEP to 0.3% (95% CI, 0.2% to 0.6%) after starting doxyPEP ( RR, 0.20; 95% CI, 0.11-) 0.37; P< .001). ”

read more: Can daily doxycycline prevent sexually transmitted diseases?

What you need to know

Doxycycline post-exposure prophylaxis (doxyPEP) significantly reduced the incidence of chlamydia (79%) and syphilis (80%) in individuals receiving HIV PrEP. However, the reduction in gonorrhea was small (12%), and the preventive effect against pharyngeal gonorrhea was limited.

DoxyPEP recipients were predominantly male (98.9%) and had an older average age (40.4 years vs. 39.8 years for non-doxyPEP users). Almost half (48.6%) had a previous STI in the year before starting doxyPEP and had been on HIV PrEP longer (4.2 years vs. 3.4 years).

Despite its limited efficacy against gonorrhea, this study concludes that doxyPEP, if widely implemented, could have significant benefits in reducing STI transmission at the population level.

Research details and other highlights

This was a retrospective cohort study of adults at least 18 years of age who received HIV PrEP at Kaiser Permanente in Northern California from November 1, 2022 to December 31, 2023. Researchers reviewed electronic health data and identified which HIV PrEP users were receiving doxyPEP and those who were not.

Of 11,551 HIV PrEP users, 2,253 (19.5%) received doxyPEP. Within this subgroup (2,228 doxyPEP users), 98.9% were male, and nearly half of them (48.6%) had an STI in the year before starting doxyPEP.

Additionally, doxyPEP recipients were older (40.4 years) compared to the non-doxyPEP group (39.8 years). The doxyPEP group also used HIV PrEP longer (4.2 years) compared to the non-doxyPEP group (3.4 years).

Although gonorrhea appears to have decreased by only 12% in this study, the limited protection against this sexually transmitted disease is a troubling concern.

“Quarterly gonorrhea positivity rates ranged from 7.6% (95% CI, 6.2% to 9.5%) to 11.3% (95% CI, 9.7% to 13.1%) before starting doxyPEP, and 7.8% (95% CI, 6.4%) % to 9.5%) to 10.7% (95% CI, 7.1%-16.1% after initiation of doxyPEP),” the authors wrote. “Overall, mean gonorrhea prevalence decreased from 10.2% (95% CI, 9.6% to 10.9%) before starting doxyPEP to 9.0% (95% CI, 8.0% to 10.1%) after starting doxyPEP. (RR, 0.88; 95% CI, 0.77-1.00; P= .048).

Other studies examining doxyPEP and doxyPrEP have also shown limited protection against them.

Overall, the researchers drew a positive conclusion. “These findings suggest that doxyPEP could have significant benefits in reducing population-level STI infections with broader implementation,” the authors wrote.

reference
1.Traeger MW, Leyden WA, Volk JE, et al. Bacterial sexually transmitted infections among individuals using doxycycline postexposure prophylaxis and HIV preexposure prophylaxis. JAMA intern doctor.Published online on January 6, 2025. doi:10.1001/jamainternmed.2024.7186

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