New CDC guidelines recommend selected use of doxy-PEP in the US (2024)
4 June 2024. Related: Guidelines, HIV prevention and transmission.
A new report from the US CDC outlines recommendation for the use of doxycycline postexposure prophylaxis (doxyPEP). Doxy-PEP is a new patient-managed biomedical STI prevention strategy for a selected population.
CDC recommends that gay and bisexual men and transgender women who have had a bacterial STI (specifically syphilis, chlamydia, or gonorrhoea) diagnosed in the past 12 months should receive counselling that doxyPEP can be used as postexposure prophylaxis to prevent these infections.
Following shared decision-making with their provider, CDC recommends that providers offer persons in this group a prescription for doxy-PEP to be self-administered within 72 hours after having oral, vaginal or anal sex. The recommended dose of doxyPEP is 200 mg and should not exceed a maximum dose of 200 mg every 24 hours.
Doxy-PEP, when offered, should be implemented in the context of a comprehensive sexual health approach, including risk reduction counselling, STI screening and treatment, recommended vaccination and linkage to HIV PrEP, HIV care, or other services as appropriate.
Persons who are prescribed doxy-PEP should undergo bacterial STI testing at anatomic sites of exposure at baseline and every 3–6 months thereafter. Ongoing need for doxy-PEP should be assessed every 3–6 months as well. HIV screening should be performed for HIV-negative MSM and TGW according to current recommendations.
No vaccines and few chemoprophylaxis options exist for the prevention of bacterial sexually transmitted infections (STIs) (specifically syphilis, chlamydia, and gonorrhoea).
These infections have increased in the United States and disproportionately affect gay, bisexual, and other men who have sex with men (MSM) and transgender women (TGW). In three large randomised controlled trials, 200 mg of doxycycline taken within 72 hours after sex has been shown to reduce syphilis and chlamydia infections by >70% and gonococcal infections by approximately 50%.
Reference
Bachmann LH et al. CDC clinical guidelines on the use of doxycycline postexposure prophylaxis for bacterial sexually transmitted infection prevention, United States, 2024. MMWR Recomm Rep 2024;73(No. RR-2):1–8. DOI: http://dx.doi.org/10.15585/mmwr.r.
https://www.cdc.gov/mmwr/