New guidance from the Centers for Disease Control and Prevention (CDC) recommends the use of a common antibiotic as a preventive measure against the spread of sexually-transmitted infections (STIs) in specific at-risk groups. The CDC proposes that healthcare providers offer a single 200-milligram dose of doxycycline to gay and bisexual men who engage in sex with men, as well as transgender women, within 72 hours of unprotected intercourse.
The CDC published the draft guidelines on Monday and has opened a 45-day period for public comment.
Studies have shown that this doxy PEP regime has resulted in a reduction in common STIs such as chlamydia, syphilis, and gonorrhea. The CDC believes it could prevent approximately 40 percent of STIs in at-risk populations.
The CDC emphasizes the need for innovative approaches to address the STI epidemic, particularly within disproportionately affected populations.
“Doxy PEP represents a leap forward in STI prevention efforts,” said Jonathan Mermin, director of the CDC’s National Center for HIV, Viral Hepatitis, STD, and TB Prevention. “We require game-changing innovations to reverse the trajectory of the STI epidemic, and this is a significant step in the right direction.”
The CDC reports a record high in STIs, posing a threat to the health of millions of Americans. Over the past decade, reported STIs have increased by 42 percent from 2011 to 2021, with more than 2.5 million cases reported in 2021 alone.
The guidance is specifically tailored to populations that are most likely to benefit, namely gay and bisexual men and transgender women who have had an STI in the past 12 months and are at high risk of reinfection.
The guidance may also be applicable to individuals in that group who have not been diagnosed with an STI in the past year but will be engaging in sexual activities that are known to increase the likelihood of exposure, such as festivals and cruises.
The CDC emphasizes that focusing on these groups, where the data indicate the greatest impact, will maximize the effectiveness of doxy PEP while minimizing overall antibiotic usage.
The CDC’s guidelines are based on four studies that explore the use of doxycycline against bacterial STIs.
Doxycycline is a commonly used and cost-effective antibiotic that is utilized for the prevention of infections such as malaria and Lyme disease. It is also the recommended treatment for chlamydia and an alternative treatment for syphilis in nonpregnant patients with severe penicillin allergy or when penicillin is unavailable.
Not many studies have been conducted on the effectiveness of doxy PEP among other groups, such as cisgender women, heterosexual men, transgender men, or other queer and nonbinary individuals.
The CDC believes that doxy PEP should be effective in other populations based on experience in treating other STIs, but further research is needed in this area.
The agency will also closely monitor the potential development of antibiotic resistance as a result of the widespread use of doxycycline.
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