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Doxycycline post-exposure prophylaxis as prevention of STIs – the golden bullet?

Kohli, Manik; Elliott-Walker, Thomas; Saunders, John; Fifer, Helen; (2025) Doxycycline post-exposure prophylaxis as prevention of STIs – the golden bullet? Expert Review of Anti-infective Therapy 10.1080/14787210.2025.2510278. (In press).

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Abstract

Introduction: Doxycycline post-exposure prophylaxis (‘doxyPEP’) is an emerging strategy to prevent bacterial sexually transmitted infections (STIs). Users take 200 mg of doxycycline up to 72 hours after condomless sex, and data from randomized controlled trials and real-world implementation have shown doxyPEP to be effective in preventing syphilis, chlamydia, and to a lesser extent gonorrhea, in gay, bisexual, and other men-who-have-sex-with-men (GBMSM) and transgender women. // Areas covered: We discuss the potential benefits, risks, and important considerations for doxyPEP implementation, drawing on published literature and our own perspectives. // Expert opinion: Is doxyPEP the golden bullet? DoxyPEP provides significant benefits through STI prevention and holistic improvements in sexual health and wellbeing. Concerns over emergent antimicrobial resistance need to be weighed against STI-related morbidity and contextualized within society’s overuse of antibiotics. Inequities in the doxyPEP evidence-base and implementation will undermine its ability to end the syphilis epidemic and reduce chlamydia associated morbidity in cisgender women. Moreover, contexts in which doxyPEP proves effective for gonorrhea prevention initially are unlikely to see a long-lasting impact. Rather than a golden bullet, doxyPEP is a bridge to the next set of STI prevention tools.

Type: Article
Title: Doxycycline post-exposure prophylaxis as prevention of STIs – the golden bullet?
Location: England
DOI: 10.1080/14787210.2025.2510278
Publisher version: https://doi.org/10.1080/14787210.2025.2510278
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Doxycycline; sexually transmitted infections; STI prevention; prophylaxis; gay, bisexual, and other men-who-have-sex-with-men; antimicrobial resistance; microbiome; equity; sexual health
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
URI: https://discovery.ucl.ac.uk/id/eprint/10209293
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