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Jim Allen: article in full:

In Brief:

--- Quote ---The Centers for Disease Control and Prevention (CDC) has issued its first proposed guidelines for using the antibiotic doxycycline as post-exposure prophylaxis to prevent bacterial sexually transmitted infections (STIs), an approach known as doxyPEP. The guidelines, published in the Federal Register on October 2, will be open for public comment for 45 days.

The proposed guidelines state that a single 200 milligram dose of oral doxycycline taken within 72 hours after oral, vaginal or anal sex should be considered for gay, bisexual and other men who have sex with men and for transgender women who have had gonorrhea, chlamydia or syphilis at least once during the past year. This is a strong recommendation supported by data from clinical trials.

The draft also says that doxyPEP “could be considered” for men who have sex with men and transgender women who have not been diagnosed with an STI if they “will be participating in sexual activities that are known to increase likelihood of exposure to STIs, e.g., during weekend events, cruises and festivals,” although this has not been directly assessed in trials.

Due to a lack of supporting evidence, however, the guidelines state that “no recommendation can be given at this time” on the use of doxyPEP for cisgender women, cisgender heterosexual men, transgender men or other queer or non-binary people.

According to the guidelines, doxyPEP “should be implemented in the context of a comprehensive sexual health approach including risk reduction counseling, STI screening and treatment, recommended vaccination and linkage to HIV pre-exposure prophylaxis (PrEP), HIV care or other services, as appropriate.”
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Interesting, but this kind of contradicts the whole “widespread use of antibiotics unnecessarily will create resistance” argument. I used to have a roomie that would take a trip to NyC every year. He’d make an appt before he even left, to visit the clinic, so upon his return he could get treated for the various STIs he’d collect while there.

Also the main argument against prep, that I’ve heard, has been that HIV isn’t the only thing you can get while engaging in unprotected sex. So maybe this will actually increase HIV prep usage.

Jim Allen:

DoxyPEP 101

--- Quote ---Here’s how doxyPEP works: A single 200 milligram dose of doxycycline is taken ideally within 24 hours—but no later than 72 hours—after anal, vaginal or oral sex. Doxycycline can be taken on consecutive days if sex is repeated, but no more than one dose in a 24-hour period. It is safe to take doxycycline with PrEP.
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--- Quote ---As part of the IPERGAY trial, a French PrEP study, a subgroup of 232 men who have sex with men were randomized to receive a single dose of doxycycline within 24 hours after sex or no STI prophylaxis. In 2017, Jean-Michel Molina, MD, of the University of Paris Cité, and colleagues reported that doxyPEP lowered the risk of chlamydia by 70% and syphilis by 73%, but it did not significantly reduce gonorrhea risk.
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--- Quote ---At the 2022 International AIDS Conference in Montreal, Annie Luetkemeyer, MD, of the University of California San Francisco, reported that doxycycline reduced STI diagnoses by 62% per quarter for HIV-positive participants and by 66% for people on PrEP. STIs were diagnosed at 11% to 12% of quarterly visits in the doxycycline group versus 31% to 32% in the standard care group. But here, too, the risk reduction was greater for chlamydia (74% in the HIV-positive group and 88% in the PrEP group) and syphilis (77% and 87%, respectively) than for gonorrhea (57% and 55%, respectively).
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Jim Allen:

By Liz Highleyman, Article in full:

In Brief:

--- Quote ---In October 2022, San Francisco was the first city to recommend doxyPEP for gay and bisexual men and transgender people. Over the next year, chlamydia cases dropped steeply and syphilis also fell, but the decline in gonorrhea was minimal. The new results from clinical practice and population-level analyses are consistent with findings from recent clinical trials.
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