In a new draft recommendation released by the US Centers for Disease Control and Prevention (CDC), health care providers are encouraged to consider prescribing a commonly used antibiotic to specific individuals as a preventive measure against chlamydia, gonorrhea, and syphilis infections. This approach, known as doxyPEP, is designed for men who have sex with men and transgender women. The CDC has opened the proposal for public comment, accepting input from interested parties and organizations until November 16.
Dr. Jonathan Mermin, the director of CDC’s National Center for HIV, Viral Hepatitis, STD, and TB Prevention, emphasized the importance of public input in shaping the final guidelines. The CDC did not specify when the official guidelines would be issued.
Doxycycline, a medication traditionally used to treat bacterial STIs after infection, is being explored as a post-exposure prophylaxis (PEP) to prevent infections when taken within 72 hours after unprotected sex. While not officially approved by the US Food and Drug Administration (FDA) for STI post-exposure prophylaxis, doxyPEP remains available as an off-label prescription for this purpose.
The CDC’s draft proposal comes at a time when the rates of sexually transmitted infections are on the rise in the United States. In 2021, over 2.5 million STI cases were reported, representing a 7% increase from the previous year. Syphilis cases reached their highest levels in more than five decades, and chlamydia and gonorrhea rates also increased significantly. Notably, congenital syphilis cases led to 220 stillbirths and infant deaths in 2021.
A study published in the New England Journal of Medicine in April found doxyPEP to be approximately 65% effective in reducing the incidence of gonorrhea, chlamydia, and syphilis in San Francisco and Seattle clinics. The study involved 500 participants who had a history of STIs and were randomly assigned to receive either doxyPEP or standard care without it. The results showed a two-thirds reduction in the combined incidence of these infections among those who took doxyPEP within 72 hours after unprotected sex.
Dr. Annie Luetkemeyer, a professor of infectious diseases, compared the concept of post-exposure prophylaxis to its use in other infectious diseases like Lyme disease. Some local health departments have already issued their own recommendations for the use of doxyPEP to prevent STIs, recognizing its potential to address the growing STI crisis.