Position statement of the German STI Society on the prophylactic use of doxycycline to prevent STIs (Doxy‐PEP, Doxy‐PrEP)

Abstract

SummaryOver the past two decades, there has been a rise in the incidence of syphilis, particularly among men who have sex with men (MSM). This has sparked interest in studying the prophylactic use of doxycycline to prevent syphilis and other sexually transmitted infections (STIs), commonly referred to as Doxycycline Pre‐ or Post‐Exposure Prophylaxis (Doxy‐PrEP, Doxy‐PEP). At the same time, demand from potential users for this preventive measure is increasing.Several randomized controlled trials have demonstrated that the prophylactic use of doxycycline in MSM and trans women using HIV pre‐exposure prophylaxis (HIV‐PrEP) or living with an HIV infection effectively reduces the risk of syphilis and chlamydia infections. At present, however, unresolved questions remain, particularly regarding implications of a broad implementation of prophylactic doxycycline to prevent STIs on tetracycline and other antimicrobial resistance in bacterial STIs, non‐STI‐related bacterial pathogens, and the microbiome.In response to the increasing demand and the challenge of balancing effectiveness, safety, and the risk of promoting antibiotic resistance, the German STI Society (DSTIG) has issued a position statement, providing specific recommendations regarding potential indications, criteria, and occasions for the use of doxycycline in STI prevention. These recommendations are based on current evidence and expert opinion.

Addressing Sexually Transmitted Infections Due to Neisseria gonorrhoeae in the Present and Future

“…Several studies have been conducted incorporating doxycycline as prophylaxis against other STIs (doxy-PrEP and doxy-PEP) [85] because of its high activity against C. trachomatis and T. pallidum and low resistance shown, regardless of the well-established resistance patterns for NG and M. genitalium [86]. Although doxy-PEP can be an excellent STI prevention strategy, more studies are necessary to investigate the long-term impact on resistance profiles [87,88].…”

Doxycycline post-exposure prophylaxis for sexually transmitted infections impacts the gut antimicrobial resistome

“…Widespread implementation of doxy-PEP among all MSM and transgender women could increase doxycycline consumption substantially, with high-end estimates of as much as 3.36 million doses per month in the U.S. 6 . As such, a primary outstanding concern is the potential for doxy-PEP to select for antimicrobial resistant bacteria and adversely impact the human microbiome [7][8][9] .…”