The Facilities for Illness Management and Prevention finalized its pointers for post-exposure prophylaxis in opposition to bacterial sexually transmitted infections on Tuesday. For teams at increased danger of contracting syphilis, chlamydia, and gonorrhea, the company now recommends taking doxycycline, an antibiotic, inside 72 hours of getting intercourse.
Doxycycline has been used to forestall malaria an infection each earlier than and after publicity, however that is the primary time the antibiotic has been used prophylactically in opposition to STIs. “Doxy PEP represents the primary new STI prevention device in a long time, at a time when innovation within the nation’s struggle in opposition to STIs is desperately wanted,” the CDC wrote within the guideline announcement. The unfold of syphilis in the US particularly has been trigger for concern in recent times, as instances attain ranges unseen because the Nineteen Fifties.
The coverage, which was proposed in October 2023, is predicated on proof from three giant randomized trials displaying {that a} 200 mg dose of doxycycline, taken after potential publicity to sexually transmitted micro organism, lowered chlamydia and syphilis infections by greater than 70%, and reduce gonorrhea infections in half.
Whereas results in opposition to gonorrhea could also be restricted, and additional interventions corresponding to vaccines could also be indicated, the prophylaxis has an opportunity of controlling the unfold of chlamydia and syphilis, mentioned Connie Celum, a professor of world well being, drugs, and epidemiology on the College of Washington. “I feel the large query now could be simply who adopts that? Can we attain the people who find themselves at highest danger? And the way effectively do they use it?” she mentioned. Watching consistency and uptake, notably as extra suppliers start prescribing doxycycline, will probably be important to know whether or not the intervention can have an effect on inhabitants well being.
Doxycycline post-exposure prophylaxis, or doxy PEP, is particularly being really helpful for males who’ve intercourse with males and transgender ladies who’ve had at the very least one bacterial STI within the earlier 12 months. The CDC mentioned suppliers ought to prescribe the antibiotic for self administration after intercourse.
Although the official pointers don’t specify that doxycycline ought to be taken after condomless intercourse, the research that the advice is predicated on examined the antibiotic after unprotected intercourse. “The advantages are actually for people who find themselves, for no matter causes, not utilizing condoms and who’re at an elevated danger of buying gonorrhea, chlamydia, and syphilis,” mentioned Celum, who was the co-principal investigator of one of many trials, DoxyPEP.
The brand new pointers largely implement final yr’s proposal, with a number of additions and clarifications, mentioned a spokesperson for the CDC. The adjustments stress shared decision-making between affected person and practitioner, noting that docs ought to evaluation a affected person’s full checklist of medicines, together with over-the-counter medicine, to keep away from interactions with doxycycline. The brand new pointers additionally verify a most day by day dose of 200 mg, and suggest reassessing a affected person’s want for prophylaxis each three to 6 months, together with common STI testing.
Primarily based on present research, potential hurt from the prophylaxis seems restricted. Doxy PEP could also be helpful for people outdoors the highest-risk teams, however analysis is restricted; the CDC recommends docs use their judgment to counsel sufferers. Commenting on the proposed pointers, the American Faculty of Obstetricians and Gynecologists urged the CDC to prioritize additional analysis of doxy PEP, notably for cisgender ladies of reproductive age who might expertise long-term reproductive well being results following STIs.
The rules additionally spotlight the significance of equitable distribution and entry, which has restricted the effectiveness of pre-exposure prophylaxis packages for HIV: In keeping with the CDC, Black women and men account for roughly 40% of individuals who qualify for PrEP, however solely 13% of customers are Black.
Ongoing research will proceed to guage the results of doxy PEP, each in stopping infections and in its attainable influence on the event of antimicrobial resistance. Thus far, mentioned Celum, doxycycline has been used for the first remedy of chlamydia and as an alternative choice to penicillin to deal with syphilis, and has not brought on resistance, although that doesn’t get rid of the necessity for ongoing surveillance.
