The Facilities for Illness Management and Prevention finalized its tips for post-exposure prophylaxis in opposition to bacterial sexually transmitted infections on Tuesday. For teams at greater threat of contracting syphilis, chlamydia, and gonorrhea, the company now recommends taking doxycycline, an antibiotic, inside 72 hours of getting intercourse.
Doxycycline has been used to forestall malaria an infection each earlier than and after publicity, however that is the primary time the antibiotic has been used prophylactically in opposition to STIs. “Doxy PEP represents the primary new STI prevention software in many years, at a time when innovation within the nation’s battle in opposition to STIs is desperately wanted,” the CDC wrote within the guideline announcement. The unfold of syphilis in america particularly has been trigger for concern in recent times, as circumstances attain ranges unseen for the reason that Nineteen Fifties.
The coverage, which was proposed in October 2023, is predicated on proof from three giant randomized trials displaying {that a} 200 mg dose of doxycycline, taken after potential publicity to sexually transmitted micro organism, lowered chlamydia and syphilis infections by greater than 70%, and reduce gonorrhea infections in half.
Whereas results in opposition to gonorrhea could also be restricted, and additional interventions akin to vaccines could also be indicated, the prophylaxis has an opportunity of controlling the unfold of chlamydia and syphilis, mentioned Connie Celum, a professor of worldwide well being, medication, and epidemiology on the College of Washington. “I believe the massive query now’s simply who adopts that? Can we attain the people who find themselves at highest threat? And the way effectively do they use it?” she mentioned. Watching consistency and uptake, significantly as extra suppliers start prescribing doxycycline, can be important to know whether or not the intervention can have an effect on inhabitants well being.
Doxycycline post-exposure prophylaxis, or doxy PEP, is particularly being beneficial for males who’ve intercourse with males and transgender ladies who’ve had at the least one bacterial STI within the earlier 12 months. The CDC mentioned suppliers ought to prescribe the antibiotic for self administration after intercourse.
Although the official tips don’t specify that doxycycline must be taken after condomless intercourse, the research that the advice is predicated on examined the antibiotic after unprotected intercourse. “The advantages are actually for people who find themselves, for no matter causes, not utilizing condoms and who’re at an elevated threat of buying gonorrhea, chlamydia, and syphilis,” mentioned Celum, who was the co-principal investigator of one of many trials, DoxyPEP.
The brand new tips largely implement final 12 months’s proposal, with just a few additions and clarifications, mentioned a spokesperson for the CDC. The adjustments stress shared decision-making between affected person and practitioner, noting that medical doctors ought to overview a affected person’s full listing of medicines, together with over-the-counter medication, to keep away from interactions with doxycycline. The brand new tips additionally affirm a most each day dose of 200 mg, and advocate reassessing a affected person’s want for prophylaxis each three to 6 months, together with common STI testing.
Based mostly on present research, potential hurt from the prophylaxis seems restricted. Doxy PEP could also be helpful for people outdoors the highest-risk teams, however analysis is restricted; the CDC recommends medical doctors use their judgment to counsel sufferers. Commenting on the proposed tips, the American Faculty of Obstetricians and Gynecologists urged the CDC to prioritize additional analysis of doxy PEP, significantly for cisgender ladies of reproductive age who might expertise long-term reproductive well being results following STIs.
The rules additionally spotlight the significance of equitable distribution and entry, which has restricted the effectiveness of pre-exposure prophylaxis applications for HIV: Based on the CDC, Black women and men account for roughly 40% of individuals who qualify for PrEP, however solely 13% of customers are Black.
Ongoing research will proceed to judge the results of doxy PEP, each in stopping infections and in its potential influence on the event of antimicrobial resistance. Thus far, mentioned Celum, doxycycline has been used for the first remedy of chlamydia and as a substitute for penicillin to deal with syphilis, and has not induced resistance, although that doesn’t get rid of the necessity for ongoing surveillance.
