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 greater 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 stop 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 USA particularly has been cause for concern in recent times, as instances attain ranges unseen because the Fifties.
The coverage, which was proposed in October 2023, relies on proof from three large randomized trials exhibiting {that a} 200 mg dose of doxycycline, taken after potential publicity to sexually transmitted micro organism, decreased chlamydia and syphilis infections by greater than 70%, and minimize gonorrhea infections in half.
Whereas results in opposition to gonorrhea could also be restricted, and additional interventions similar to vaccines could also be indicated, the prophylaxis has an opportunity of controlling the unfold of chlamydia and syphilis, stated Connie Celum, a professor of world well being, drugs, and epidemiology on the College of Washington. “I feel the massive query now could be simply who adopts that? Can we attain the people who find themselves at highest danger? And the way properly do they use it?” she stated. Watching consistency and uptake, notably as extra suppliers start prescribing doxycycline, can 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 beneficial for males who’ve intercourse with males and transgender girls who’ve had a minimum of one bacterial STI within the earlier 12 months. The CDC stated suppliers ought to prescribe the antibiotic for self administration after intercourse.
Although the official pointers don’t specify that doxycycline needs to be taken after condomless intercourse, the research that the advice relies 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,” stated 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 couple of additions and clarifications, stated a spokesperson for the CDC. The modifications stress shared decision-making between affected person and practitioner, noting that medical doctors ought to evaluate a affected person’s full record of medicines, together with over-the-counter medicine, to keep away from interactions with doxycycline. The brand new pointers additionally affirm a most every day dose of 200 mg, and advocate 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 exterior the highest-risk teams, however analysis is proscribed; the CDC recommends medical doctors 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 girls of reproductive age who could 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: According to the CDC, Black women and men account for about 40% of individuals who qualify for PrEP, however solely 13% of customers are Black.
Ongoing research will proceed to judge the results of doxy PEP, each in stopping infections and in its attainable impression on the event of antimicrobial resistance. Thus far, stated Celum, doxycycline has been used for the first therapy of chlamydia and as an alternative choice to penicillin to deal with syphilis, and has not induced resistance, although that doesn’t eradicate the necessity for ongoing surveillance.
