May 8, 2023 — “Think of it like a morning-after pill, but for STIs,” was how Aniruddha Hazra, MD, put it. Hazra specializes in infectious diseases in the unit of Infectious Disease Medicine and Global Health at the University of Chicago.
The cause of the big statement? New research showing that the antibiotic doxycycline reduces the occurrence of HIV and sexually transmitted infections (STIs) by two-thirds after exposure.
“So while a morning-after pill can be a prophylaxis (or prevention) against pregnancy, doxycycline can be used shortly after sexual contact or possible exposure to an STI to prevent acquiring an infection,” Hazra said. , who did not participate in the study. the said.
The new research from the National Institutes of Health was intended to support previous case studies of doxycycline in a clinical trial of men who have sex with men, said lead investigator Anne Luetkemeyer, MD, an infectious disease specialist at the University of California. , San Francisco. .
Earlier research from France in 2016 seemed to show that doxycycline, or doxy, worked against sexually transmitted diseases. But Luetkemeyer’s team wanted to confirm those findings and study its effects in a different population, he said.
This randomized, controlled trial found that doxycycline reduced the incidence of sexually transmitted infections such as chlamydia and syphilis. Men assigned male at birth demonstrated the benefits of a two-thirds prevention rate. A 2022 study involving women in Kenya showed limited or no prevention with doxycycline.
Doxycycline is an antibiotic of the tetracycline class. Like all antibiotics, it stops or slows bacterial infections but not viral ones. Doxycycline is used to treat anthrax, malaria, acne, and other conditions. A prescription for the antibiotic costs just pennies if you have insurance.
Research published in April in the New England Journal of Medicine shows the widest application of doxycycline in reducing HIV and STIs in men who have sex, men and trans women.
The 2023 federally funded study shows that study participants, who reported having had a sexually transmitted infection in the past year, reduced their risk of renewed infection by two-thirds with antibiotic protection.
The study, led by researchers from the University of California, San Francisco and the University of Washington, enrolled about 500 adults from four clinics in San Francisco and Seattle. All study participants were assigned male at birth, reported sexual activity, and had a history of STI or HIV diagnosis.
The trial found that 10.7% of patients taking doxycycline had an STI diagnosis compared to 31.9% in the control group, a two-thirds reduction in STI cases. HIV diagnosis for doxycycline patients was 11.8% versus 30.5% in control, again a reduction of almost two-thirds.
Although there have been no reports of doxycycline resistance in chlamydia or syphilis cases, Luetkemeyer said researchers are looking at strains of doxy-PrEP for people who have developed advanced infections to look for evidence of resistance.
“We certainly need to be vigilant about that possibility,” Luetkemeyer said. “But it hasn’t been described yet. And certainly a lot of syphilis and a lot of chlamydia have been treated with doxycycline so far.”
Trevor Hedberg, a physician assistant and director of the Sexual and Reproductive Health Outpatient Clinic at Howard Brown Health in Chicago, said two patients mentioned doxine as a pre-exposure treatment in the last 6 months. He said the clinic generally recommends doxycycline for people assigned male at birth who do sex work or who have been diagnosed with syphilis in the past.
“So, you know, the way I approach conversations about doxy PrEP is based on the STI story,” Hedberg said. “How the patient perceives their risk of exposure to STIs, and going over the side effects and safety profile of doxycycline and whether it’s something he feels comfortable taking.”
Over the years, people have become more accepting of using doxy for pre-exposure protection, with the main concern being antibiotic resistance, said Zach Bird, a health educator at Center on Halsted, a community center dedicated to to the health of LGBTQ+ people in the Chicago area
“I see why there is a need for doxy research because there have been more reported cases of bacterial STIs and syphilis,” Bird said.
At first, “a lot of people shamed people who took [doxy] PrEP to be able to access more sex. I don’t really see that happening, at least in the community that I serve,” Bird said. “But the people I’ve heard from have more things like: you don’t know if a resistance is going to develop, if we’re going to have a super gonorrhea or something like that eventually.”
STI and HIV reduction through doxycycline applies primarily to those who are assigned male at birth.
“I would say in the meantime, until we have more information on cisgender women, that’s not a population for which PrEP doxy is recommended,” Luetkemeyer said. “I would also say that this really isn’t a general population intervention yet.”
Hazra said that doxycycline is one of the most prescribed outpatient antibiotics in the last 5 years after the ANRS investigation in France. However, she advised against the prescription for pregnant women because of tetracycline’s potential risk of birth defects, including tooth discoloration and bone abnormalities.
The CDC has published doxycycline prescribing considerations, but not detailed guidance. The San Francisco Department of Public Health, where Luetkemeyer practices, has published recommendations for cisgender men and trans women.
Men who have sex with men are one of the groups most at risk of being disproportionately affected by HIV. According to the CDC, the lifetime risk of HIV infection among MSM is 1 in 6 compared to one in 524 for heterosexual men or one in 253 for heterosexual women.
“Believe [doxy PrEP] it’s a really good tool in the toolbox for people who need additional STI prevention measures, and the way we see it is to try to offer this to people who are most at risk,” said Luetkemeyer.
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