By Stan Deresinski, MD, FACP, FIDSA
Clinical Professor of Medicine, Stanford University
SYNOPSIS: Single-dose doxycycline is recommended after oral, vaginal, or anal sex in selected high-risk individuals.
SOURCE: 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;73:1-8.
Bachmann and colleagues outlined the new Centers for Disease Control and Prevention (CDC) recommendations for the use of doxycycline postexposure prophylaxis (doxy PEP) in prevention of sexually transmitted infections (STIs) with Treponema pallidum, Chlamydia trachomatis, or Neisseria gonorrheae in high-risk groups.
Targeted groups include men who have sex with men (MSM) and transgender women who had had at least one episode of syphilis, Chlamydia infection, or gonorrhea in the previous 12 months. After counseling regarding risks and benefits, and with shared decision-making, patients should be offered doxy PEP consisting of a single 200-mg dose of doxycycline within 72 hours after oral, vaginal, or anal sex. The continued need for doxy PEP should be reevaluated every three to six months. While these recommendations were based on high-quality evidence, it was assessed that insufficient evidence existed to make recommendations regarding the use of doxy PEP in cisgender women or heterosexual men, transgender men, and other queer and nonbinary individuals. Subjects should be screened for STIs (including human immunodeficiency virus [HIV]) if not known to be infected at the initial visit. Screening for syphilis, chlamydia, and gonorrhea should be repeated every three to six months.
COMMENTARY
The incidence of an STI in the United States has been progressively increasing.1 At the same time, national data indicate that both adolescents and adults are having less sex.2 This apparent paradox may potentially be explained by increasing activity in high-risk populations while sexual activity may have diminished in the more general population.
The identification of high-risk groups allows targeting of effective prophylaxis while avoiding the wider population risk of selection of antibiotic-resistant bacteria. At any rate, we now can add doxy PEP to HIV pre-exposure prophylaxis (PrEP) in our preventive armamentarium.
References
- Centers for Disease Control and Prevention. Sexually transmitted infections surveillance, 2022. Last reviewed Jan. 30, 2024. https://www.cdc.gov/std/statistics/2022/default.htm
- Herbenick D, Rosenberg M, Golzarri-Arroyo L, et al. Changes in penile-vaginal intercourse frequency and sexual repertoire from 2009 to 2018: Findings from the National Survey of Sexual Health and Behavior. Arch Sex Behav 2022;51:1419-1433.
