A study found oral antibiotic doxycycline to prevent acquisition of sexually transmitted infections (STIs) among men who engaged in sex with men (MSM) and transgender women, who took the medication within 72 hours of having condomless sex. It also revealed slight increase of antibacterial resistannce among participants which is yet to be explored in further studies.
Moreover, the study also found that the post-exposure approach termed as “doxy-PEP” significantly reduced incidence of syphilis, gonorrhea, and chlamydia to approximately 65% of study participants, previously reported to have STI within the previous year.
Researchers from the University of California San Francisco (UCSF) and the University of Washington led the study which was also funded by the National Institute of Allergy and Infectious Diseases (NIAID) which is part of the National Institutes of Health (NIH).
They employed 501 adults in the study, all of whom were at least 18 years of age, assigned male sex at birth and reported to be sexually active with a biological man. Participants were previously either diagnosed with HIV, taking or planning to take pre-exposure prophylaxis (PrEP) medication for HIV prevention, diagnosed with gonorrhea, chlamydia or early syphilis in the year prior to their enrollment to the study.
Participants were then randomly assigning to a doxy-PEP group and a group who will receive standard of care. Doxy-PEP groups are instructed to take in 200 mg doxycycline delayed released tablets within 24 hours but no later than 72 hours after condomless sex.
Study findings showed that participants had positive adherence to the medication with 86.2% reporting talking doxy-PEP consistently within 72 hours of condomless sex, and 71.3% reported never missing a dose.
In a statement, Annie Luetkemeyer, M.D., professor of infectious diseases at Zuckerberg San Francisco General Hospital at UCSF, and co-principal investigator of the study, said: “Given its demonstrated efficacy in several trials, doxy-PEP should be considered as part of a sexual health package for men who have sex with men and transwomen if they have an increased risk of STIs.”
As for the second findings concerning antimicrobial resistance during doxy-PEP use, researchers found that tetracycline resistance in a greater number of incident gonorrhea strains among those in the doxy-PEP group compared to those in the standard of care group (38.5% versus 12.5%, respectively). Such is suggestive that doxy-PEP may offer less protection against gonorrhea strains since the condition is already tetracycline-resistant. Currently, additional research is on the work to examine potential antimicrobial resistance effect of intermittent doxy-PEP use.
In a same release, Dr. Connie Celum, Professor of Global Health and Medicine at the University of Washington and co-principal investigator of the Doxy-PEP Study, shared:
“We need new, effective STI prevention methods and three studies have now demonstrated that doxy-PEP significantly reduces gonorrhea, chlamydia and syphilis. In the next several years during the implementation of doxy-PEP, we need to learn about maximizing equitable access and impact.”
At the status quo, STI incidence in the United States continue to balloon over the past few years, prevalently affecting MSM and transgender women populations. Center for Disease Control and Prevention estimated about 2.5 million cases of syphilis, gonorrhea, and chlamydia occurred in 2021 up from 2.4 million cases in 2020. Despite continuing advancement in STI medication, antimicrobial resistance in STIs is still considered an emerging public health threat, particularly with Neisseria gonorrhoeae, and threatens available treatment options.
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