Optimizing a common antibiotic within 72 hours after engaging in unprotected sex can significantly decrease the risk of sexually transmitted infections (STIs), particularly within the LGBTQ+ community. The Centers for Disease Control and Prevention (CDC) recently announced its intention to offer doxycycline, an affordable antibiotic, as part of a regimen known as doxy-PEP to gay men, men who have sex with men, and transgender women who engage in unprotected sex. The CDC believes that this antibiotic has the potential to prevent up to 40% of STIs, including chlamydia, gonorrhea, and syphilis, which have reached epidemic proportions in the US. Dr. Jonathan Mermin, the director of the CDC’s National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), stated that doxy-PEP represents a significant advancement in STI prevention efforts. The recommended dosage for doxy-PEP has not yet been specified, and the CDC is seeking public input on its proposal until November 16. Doxycycline is an affordable antibiotic that has been available in the US for over 50 years. Research indicates that it may hold promise in reducing the risk of STIs.
In 2021, Mississippi reported the highest number of STDs per 100,000 individuals, totaling 1,266 cases. The state also had the highest rates of gonorrhea, with 427.7 infections per 100,000 people. Doxy-PEP is primarily intended to lower the risk of STIs, and the traditional morning-after pill, Plan B, should still be taken within 72 hours of unprotected sex to prevent unintended pregnancies. Engaging in unprotected sex with an infected individual increases the likelihood of contracting an STI. Earlier this year, the CDC issued a warning that the US is currently experiencing an “STI epidemic” that shows no signs of slowing down. The most recent data shows that there were 176,713 cases of syphilis in 2021, the highest number since 1950 and a 33% increase from 2020. Additionally, cases of congenital syphilis, which occurs when a baby contracts the infection from its mother during pregnancy, rose by 32% from 2020 to 2021. This resulted in 220 stillbirths and infant deaths in 2021. Cases of gonorrhea increased by nearly 5% from 2020 to 2021, reaching the highest yearly total in four years. Chlamydia cases, the most common STI, also increased from 1.58 million in 2020 to 1.64 million in 2021. However, the total number of yearly chlamydia cases has been decreasing since 2019, potentially due to COVID-19 social distancing measures and reduced testing during the pandemic.
Doxycycline is an affordable antibiotic that has been available in the US for over 50 years. It is commonly used to treat bacterial infections, such as urinary tract and respiratory tract infections, as well as skin conditions like rosacea. Recent research suggests that it may also be effective in reducing the risk of STIs. A study published in the New England Journal of Medicine, funded by the National Institutes of Health (NIH), involved 501 participants who identified as gay men, bisexual men, or transgender women in Seattle and San Francisco. These individuals had a history of STI infections and each took a 200 mg doxycycline pill within 72 hours of engaging in unprotected sex. The study found that participants who took the medication were about 90% less likely to contract chlamydia, 80% less likely to contract syphilis, and over 50% less likely to contract gonorrhea compared to those who did not take the medication. There is currently less evidence regarding the effectiveness of doxy-PEP in cisgender and heterosexual men and women, but experts believe that as more studies are conducted, this may change.
The overall number of STI cases, including chlamydia, gonorrhea, and syphilis, has been on the rise for the past seven years. Although infections decreased in 2020, CDC officials believe that this was due to a decrease in testing during the COVID-19 pandemic, rather than an actual decrease in cases. Doctors at the University of California, San Francisco, and the University of Washington support the use of doxycycline as a prophylactic for men who have sex with men. They found that the combined incidence of gonorrhea, chlamydia, and syphilis was two-thirds lower in participants who took doxy-PEP compared to those who received standard care. It is worth noting that there is currently less evidence regarding the effectiveness of doxy-PEP in cisgender and heterosexual men and women. However, Dr. Mermin believes that as more research is conducted, this may change. The San Francisco Department of Public Health endorsed the use of doxycycline as a prophylactic in October of last year, citing ongoing studies in the field and an increase in community awareness.
According to state statistics from the CDC, Mississippi and Louisiana have the highest rates of STDs in the US. Mississippi reported the highest rates of gonorrhea and chlamydia in the country, with 427.7 infections and 750 infections per 100,000 people, respectively. The state also had a syphilis rate of 88.3 cases per 100,000. Following Mississippi, the state with the second-highest STD rate was Louisiana, with a chlamydia rate of 730.1 cases per 100,000 and a gonorrhea rate of 354.5 cases per 100,000. Alaska ranked third in terms of overall STD rates, with increasing rates of gonorrhea and syphilis in recent years. In 2021, Alaska reported 447 cases of syphilis, a 24% increase from the previous year. Factors contributing to these high rates include a relatively young population and limited access to healthcare in remote areas. South Carolina ranked fourth in STD rates, with 1,052 cases per capita in 2021. The state had high rates of chlamydia and the lowest syphilis rate on the list. South Dakota rounded out the top five states, with limited access to healthcare in rural and tribal lands and a significant increase in syphilis cases.
While the CDC has not yet formally recommended doxycycline as a morning-after pill, they are considering various factors, including the drug’s adverse effects on health. For example, when combined with a blood thinner like warfarin, doxycycline can further thin the blood, increasing the risk of excessive bleeding and bruising. Other medications, such as antacids and certain sedatives, can also diminish the effectiveness of doxycycline. Side effects of doxycycline can include nausea, vomiting, bloating, dizziness, constipation, and in more severe cases, rashes, swelling, hives, and blurred vision.
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