Dr Ranj on doxyPEP – Is this the silver bullet for STIs?

In June, I went to my very first Sitges Pride, accompanied by a lively group of friends. On the sun-kissed coast of Spain, Sitges is renowned for its vibrant LGBTQ+ scene, and Pride week truly brings this charming town to life. As we strolled through the bustling streets adorned with rainbow flags, we found ourselves engaging in discussions about everything from work to relationships to sex. But one topic sparked particular interest and debate: PrEP (pre-exposure prophylaxis). 

Many of us will already be familiar with PrEP, and my friends were fortunately no exception. Some of them were already using it and spoke about the sense of security it provided, allowing them to enjoy their relationships without the constant worry of HIV. Others were curious but cautious. Questions about side effects, accessibility, and the necessity of daily medication were raised. One thing was universally acknowledged though: while it’s been a game-changer in HIV prevention, PrEP is by no means a silver bullet — especially when it comes to other STIs. Indeed, there is a concern that the reduced use of condoms may be behind the increase in other infections, including chlamydia and syphilis. 

However, there is some potential hope on the horizon in the form of doxyPEP. Short for doxycycline post-exposure prophylaxis, it represents a groundbreaking approach to STI prevention. So why is it generating so much buzz in the medical community? 

Doxycycline has been a go-to treatment for various bacterial infections for years. Now, in some parts of the world, it’s being repurposed to thwart STIs following potential exposure. The regimen typically involves a single 200mg dose ideally within 72 hours post-exposure (the sooner the better).  

“While the promise of doxyPEP is exciting, it comes with its challenges”

DoxyPEP is primarily aimed at preventing bacterial STIs such as chlamydia, syphilis and gonorrhoea. Its effectiveness has been demonstrated in several studies. For example, research focusing on men who have sex with men (MSM) has shown a significant reduction in chlamydia and syphilis among those using doxyPEP. However, effectiveness against gonorrhoea hasn’t been quite as good. 

While the promise of doxyPEP is exciting, it comes with its challenges. One of the primary concerns is antibiotic resistance. The more we use antibiotics, the greater the chance that bacteria will develop ways to survive these drugs, rendering them less effective. Gonorrhoea, in particular, has a well-earned reputation for developing resistance to antibiotics, and widespread use of doxycycline could exacerbate this issue. 

Then there are the side effects. Common reactions to doxycycline include gastrointestinal discomfort and photosensitivity, which can increase the risk of sunburn. In rare cases, it can cause more severe issues, like oesophageal irritation or allergic reactions. For these reasons, doxyPEP isn’t suitable for everyone and should be used under medical supervision. 

Another layer to the doxyPEP discussion is the potential for risk compensation, where individuals might engage in riskier sexual behaviours because they feel protected by the antibiotic. This could undermine other prevention strategies, such as condom use, and might ultimately lead to an overall increase in STI transmission. 

So far, doxyPEP has been implemented quite successfully in San Francisco and Seattle, but it’s not universally recommended and remains under evaluation in various clinical trials. Researchers are working to determine the best protocols and to monitor for signs of antibiotic resistance. It’s not currently approved for use in the UK, but there are reports of people ordering it online unofficially, which could prove risky. 

DoxyPEP stands as a promising addition to the arsenal against STIs, especially for high-risk groups. However, its use must be carefully managed to balance its benefits with the risks of antibiotic resistance and other concerns. As research continues and guidelines evolve, doxyPEP could become a key player in the future of STI prevention.  

Book Your Post-Pride MOT Now! 

Have you had a good Pride season? And by ‘good’, I mean GOOD?! Then take this as a reminder to book yourself a sexual health MOT.  

 Remember, if you can’t — or don’t want to — attend a clinic in person, you can usually order a free home testing kit. It’s possible to get an HIV test result on the spot in 15 minutes. Just search for ‘free home sexual health testing kit’ to find a service close to you.