Doxycycline Post-Exposure Prophylaxis for Bacterial Sexually Transmitted Infections: The Current Landscape and Future Directions

Curr HIV/AIDS Rep. 2024 Oct 30;22(1):1. doi: 10.1007/s11904-024-00709-w.

Abstract

Purpose of review: The incidence of bacterial sexually transmitted infections (STI) continues to rise particularly among men who have sex with men (MSM). Doxycycline post-exposure prophylaxis (doxy-PEP) has emerged as a promising biomedical prevention strategy. This review aims to summarize the results of recent studies, highlight the current normative guidance on the use of doxy-PEP, and discuss remaining questions.

Recent findings: In the past decade, there have been four randomized controlled trials and three real-world analyses of doxy-PEP, which consistently demonstrated a reduction in Chlamydia trachomatis and Treponema pallidum infections among MSM. Questions remain regarding the efficacy of doxy-PEP for Neisseria gonorrhoeae infection and among cisgender women. Possible detrimental impacts include an increase in antimicrobial resistance as well as alterations to the gut microbiome Doxy-PEP is an effective strategy for preventing Chlamydia trachomatis and Treponema pallidum among MSM. Further work is needed to investigate the benefits among other populations, as well as to monitor for adverse effects.

Keywords: Doxycycline post-exposure prophylaxis; Narrative review; Sexually transmitted infection prevention.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents* / administration & dosage
  • Anti-Bacterial Agents* / adverse effects
  • Anti-Bacterial Agents* / therapeutic use
  • Chlamydia Infections / prevention & control
  • Chlamydia trachomatis / drug effects
  • Doxycycline* / therapeutic use
  • Female
  • Gonorrhea / prevention & control
  • Homosexuality, Male
  • Humans
  • Male
  • Post-Exposure Prophylaxis* / methods
  • Sexually Transmitted Diseases, Bacterial* / prevention & control

Substances

  • Doxycycline
  • Anti-Bacterial Agents