This article has been republished with permission from ACON’s endinghiv.org.au.
PrEP has been a tremendous tool in preventing new HIV transmissions; however, sexually transmitted infections (STIs) remain relatively common in many men’s sex lives.
While condoms remain a tried and tested way of preventing STIs, Doxy-PEP may now also be able to assist in reducing STI transmissions.
As more people in NSW begin using it, you may be hearing more about it. Here’s what you need to know.
What is Doxy-PEP?
Doxy-PEP is the use of the antibiotic doxycycline after sex to protect against STIs, specifically syphilis and chlamydia.
Doxycycline is also used to treat a range of bacterial infections, including STIs and is even prescribed to prevent malaria transmission and treat acne at different doses.
Research has shown that using Doxy-PEP is highly effective at preventing certain STIs among gay, bisexual, and other men who have sex with men.
Clinical trials of Doxy-PEP have shown significant reductions in syphilis (by 70-80 per cent) and chlamydia (by 70-90 per cent). However, due to antibiotic resistance, it’s unlikely to protect against gonorrhoea, which is why it’s important to maintain regular STI check-ups every three months.
In September 2023, ASHM (Australia’s peak body for HIV, blood-borne viruses, and sexual and reproductive health) listed Doxy-PEP as an option for men who are most at risk of STI transmission.
As of September 2024, NSW Health has created a decision aid to guide your discussion with your doctor (GP) and formally made a pathway for people at risk of STIs to access Doxy-PEP.
How do I take Doxy-PEP?
To use Doxy-PEP, you take 200 mg of doxycycline (usually two tablets) up to 72 hours after sex to reduce your risk of bacterial STIs. So, if you have multiple encounters over the weekend, a single dose of Doxy-PEP (as described above) is sufficient to help prevent transmission.
Here’s a visual example of how it could work:
Other tips for taking Doxy-PEP
- Take doxycycline with food and a full glass of water to prevent stomach upset (NSW Health)
- Avoid lying down for at least an hour after swallowing the tablets to avoid irritating your food pipe
- Do not take antacids, iron, calcium, zinc or fibre supplements within 2 hours of doxycycline as they may interfere with its absorption
- Apply sunscreen when out in the sun to avoid sunburn
It’s not recommended to take doxycycline more frequently than once every three days, which otherwise might be thought of as “Doxy-PrEP” (taking 100 mg daily).
While an argument can be made for its use among men during periods of heightened (daily) sexual activity, we don’t yet have a clear idea of its efficacy for use in this way. So we’d recommend including this in your discussion with your doctor if this is something you’re looking to do.
Is Doxy-PEP safe to take at the same time as PrEP for HIV?
Yes, it’s safe to take PrEP at the same time as Doxy-PEP; in fact, all participants of the Doxy-PEP trials that led to this development were either taking HIV PrEP or HIV treatment.
Who is Doxy-PEP for?
Doxy-PEP has been recommended for gay, bisexual, and other men who have sex with men and trans women, especially with recent syphilis or multiple recent STIs. However, it can be prescribed to anyone who wishes to reduce their risk of syphilis and chlamydia and understands the associated risks and benefits.
Doxy-PEP and antimicrobial resistance
As our collective use of antibiotics to treat a whole host of illnesses continues, there have been concerns raised about the rise of antimicrobial-resistant (also known as antibiotic-resistant) bacteria across the world.
Antimicrobial resistance can mean certain antibiotic treatments are rendered ineffective in treating STIs or other types of bacterial infections, which can have serious consequences for individuals and the broader public health response.
For STIs, this is an issue for gonorrhoea. Widespread use of Doxy-PEP may increase resistant gonorrhoea strains in the community. It is important to weigh these concerns against the benefits of Doxy-PEP, particularly in preventing the serious health complications associated with syphilis.
With this in mind, it’s important that any use of Doxy-PEP is carefully monitored. This can be achieved by obtaining it through a doctor who prescribes it, rather than using pills acquired through other means or intended for different treatments.
There have been reports of people already using doxycycline as Doxy-PEP from left-over medication and using other forms of antibiotics to try and achieve a similar effect. While it’s great to see people are motivated to try new STI prevention methods, it’s important to access Doxy-PEP in conjunction with your doctor to make sure it’s being taken safely and effectively. ASHM advises against using other antibiotics to prevent STIs.
How can I get Doxy-PEP?
While Doxy-PEP may not be the right option for everyone, it is now possible to access it through your doctor (GP) if you want to. Be sure to read through the NSW Health’s Doxy-PEP decision-aid document before you book an appointment, available via the URL gaysydneynews.com.au/doxypep.
Editor’s Note: This article has been republished with permission from ACON. Minor edits have been made for clarity. For more articles like this one, visit Ending HIV.
Ending HIV is an initiative by ACON, a health promotion organisation specialising in HIV prevention and support for LGBTQ+ communities in NSW. Its campaign aims to virtually eliminate HIV transmissions.