Experts say some are already using so-called doxy-PEP, and now they've released a consensus statement to guide clinicians.
A new Australian consensus statement supporting the novel use of prophylactic doxycycline for STI prevention in high-risk gay and bisexual men will provide clinicians with guidance on how to use it safely and effectively, say experts.
Doxy-PEP, otherwise known as doxycycline post-exposure prophylaxis, involves taking a single dose of doxycycline 200mg within 72 hours of unprotected sexual activity act to reduce the risk of bacterial STIs, according to the statement developed by the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM)
Some Australians are already using this antibiotic for STI prevention, the authors revealed, and it was important to ensure that it was appropriately prescribed to minimise the risk of antimicrobial resistance and other health impacts, they said.
The Australian Consensus Statement on Doxy-PEP and recommendations was formally launched at the Australasian Sexual and Reproductive Health Conference, hosted by ASHM in Sydney this month.
Clinical trials of doxy-PEP among men who have sex with men had shown “significant reductions” in syphilis (by 70–80%) and chlamydia (by 70–90%). The results were less promising in preventing gonorrhoea, with some trials showing it to be ineffective, and others showing a 50–55% reduction, “due to varying levels of tetracycline resistance in gonococcal isolates in different populations”, according to the statement.
“However, uncertainty remains regarding unintended outcomes from doxy-PEP. These may include harms to individuals taking doxy-PEP, such as disruptions to their microbiome and increased antimicrobial resistance (AMR) in STIs and other organisms, and harms to the community through increased population-level AMR,” the statement said.
“As such, individuals who might benefit from doxy-PEP need to be supported to weigh up the potential benefits versus the potential harms from using doxy-PEP, while considering whether this STI prevention strategy is suitable for them in their current context, in addition to conventional STI prevention strategies such as condoms.”
Associate Professor Vincent Cornelisse, ASHM clinical adviser and co-author of the consensus statement, said “some people are already using doxy-PEP for STI prevention in Australia”.
“We need to make sure clinicians and those wishing to use doxy-PEP have access to the best information available about how to use it as effectively and safely as possible,” he said.
“Our recommendations aim to target doxy-PEP to the people who would most benefit from it, with a focus on gay, bisexual and other men who have sex with men.”
Dr Nicholas Medland, ASHM president and fellow co-author, said clinicians needed to consider that using more antibiotics could adversely affect the health of individuals, though impacts to the gut microbiome, and could potentially contribute to antimicrobial resistance.
“Using doxy-PEP will always require us to think about how we balance the benefits of STI-prevention against any potential risks,” he said.
“We also need to make sure discussions of those risks do not stigmatise or otherwise blame those wishing to use doxy-PEP.”
According to the consensus statement, this approach may be considered for gay, bisexual and other men who have sex with men with a recent (within six–12 months) syphilis diagnosis; with two or more recent (within six-12 months) other bacterial STI diagnoses; who identify an upcoming period of heightened STI risk, for example, attendance at a sex event, or holiday plans that likely involve sexual activity with multiple casual sexual partners; or who have concurrent male and cisgender female sexual partners or other sexual partners with a uterus, recognising the additional health risks posed by chlamydia, gonorrhoea and syphilis for people with a uterus.
The statement recommends doxy-PEP be used for a pre-defined period, for example, three to six months, followed by review of the need for ongoing use. Doxy-PEP users should continue to undergo STI screening in line with STI testing guidelines for men in this risk category (currently, every three months), and should also be encouraged to attend for STI testing whenever they have symptoms.
To read the full list of recommendations, see the Australian Consensus Statement on Doxy-PEP here.