You’ll hear buzz about “doxy PEP”...to prevent bacterial sexually transmitted infections (STIs).
That’s because CDC now recommends prescribing doxycycline for certain high-risk patients to take after sex as POSTexposure prophylaxis (PEP).
Evidence suggests that doxy PEP prevents a new bacterial STI in about 1 in 3 patients per year.
Be aware, these data are in men who have sex with men (MSM) or transgender women (TGW)...with a prior bacterial STI in the past year.
It’s too soon to say if doxy PEP is effective for other patients...or if other antibiotics work.
Clarify that the jury’s still out over whether this new recommendation will increase antimicrobial resistance. But doxy PEP should reduce overall antibiotic prescribing for STI treatment.
Keep doxy PEP top of mind when talking with all sexually active patients...similar to discussions about HIV PrEP or PEP. Use gender-neutral language to help create a safe space for sexual health dialogue.
Recommend doxy PEP for MSM or TGW...with syphilis, chlamydia, or gonorrhea in the past year.
Also consider doxy PEP for other MSM or TGW patients with risks for STI exposure...unprotected sex, multiple partners, etc.
Suggest any oral formulation of doxycycline...for a single 200 mg dose. Generally advise using immediate-release pills. It’s okay to use delayed-release doxycycline...but it’s more costly.
Educate to take a dose as soon as possible within 72 hours after having oral, vaginal, or anal sex.
Clarify to limit to one 200 mg dose in 24 hours, even if having sex more frequently.
Expect the number of doses to align with anticipated sexual activity until the patient’s next clinic visit. Emphasize regular follow-up and open dialogue with their prescriber.
Reinforce that doxy PEP does NOT replace safer sex practices...condom use, reducing the number of sex partners, proper screening, etc.
Advise patients to take doxycycline with plenty of water and food in their stomach...and to stay upright for at least 30 minutes afterward.
But counsel not to take it within 2 hours of dairy, antacids, or supplements with calcium, iron, or magnesium.
Point out that doxycycline does not interact with hormonal therapies or antiretroviral medications.
- Bachmann LH, Barbee LA, Chan P, et al. CDC Clinical Guidelines on the Use of Doxycycline Postexposure Prophylaxis for Bacterial Sexually Transmitted Infection Prevention, United States, 2024. MMWR Recomm Rep. 2024 Jun 6;73(2):1-8.
- Traeger MW, Mayer KH, Krakower DS, et al. Potential impact of doxycycline post-exposure prophylaxis prescribing strategies on incidence of bacterial sexually transmitted infections. Clin Infect Dis. 2023 Aug 18:ciad488. doi: 10.1093/cid/ciad488.
-
Checklist:
HIV Pre-Exposure Prophylaxis (PrEP)
-
Checklist:
HIV Postexposure Prophylaxis (PEP) Checklist
- Chart: Treatment of Gonorrhea