Post-exposure doxycycline reduces STIs | MedPage today

MONTREAL — Men who have sex with men appeared to avoid getting gonorrhea, chlamydia and syphilis by taking a single dose of the antibiotic doxycycline after having sex without a condom, researchers here said.

Among 327 participants taking pre-exposure prophylaxis (PrEP) to prevent human immunodeficiency virus (HIV), new sexually transmitted diseases (STDs) occurred in 32% of those in the control group and 11% of those of the doxycycline group of the DOXY/PEP study, reports Annie Luetkemeyer, MD, of the University of California, San Francisco.

At a press conference at the International AIDS Conference, Luetkemeyer said the difference represented a 66% reduction in STDs per quarter (P

Similarly, she said, of 174 people living with HIV, new STDs occurred in 30.5% of the control group versus 12% in the doxycycline group, a reduction of 62% per trimester (P

“This is truly fascinating work on the prevention of sexually transmitted diseases. This is a game-changing sexually transmitted infection prevention strategy,” said Sharon Lewin, MD, president-elect of the International Society of AIDS and infectious disease specialist at the University of Melbourne, Australia.

“We look forward to hearing about the implementation of this very simple intervention,” said Lewin, the host of the press conference where the DOXY/PEP study was presented.

“Our study,” said Luetkemeyer, “demonstrated that a single dose of doxycycline taken after condomless sex is a safe and highly effective strategy for reducing infections with sexually transmitted diseases in populations heavily affected by HIV infection. ongoing epidemic of sexually transmitted diseases”.

Luetkemeyer cited the ongoing epidemic of infections such as syphilis, gonorrhea and chlamydia in the United States and many other parts of the world.

“Men who have sex with men and transgender women are disproportionately affected by this epidemic, and particularly people living with HIV and those taking HIV pre-exposure prophylaxis,” she said. declared. “The oral antibiotic doxycycline has shown promise as a potential strategy for reducing sexually transmitted diseases when taken after sex without a condom.”

She and her research associates investigated the effectiveness of doxycycline as post-exposure prophylaxis (PEP) in a randomized, open-label clinical research project recruiting participants from HIV sexual health clinics in Seattle and San Francisco.

Eligible participants had to be male at birth, living with HIV or taking HIV PrEP, and a history of bacterial STDs and condomless sex with a male partner, both within the year prior to registration. The median number of sexual partners over the past 3 months was nine.

DOXY/PEP participants were randomized 2:1 to take 200 mg of doxycycline as soon as possible within 24 hours after unprotected sex or they were randomized according to standard of care.

All STD endpoints were reviewed by a blinded endpoints committee.

The control arm of our study was stopped in early May 2022 when a planned interim analysis determined that the doxycycline group had significantly fewer STDs, both in people living with HIV and in those taking PrEP for HIV. HIV.

Participants reported taking doxycycline 87% of the time after having sex without a condom. About half of the participants took less than 10 doses per month; 30% took 10 to 20 doses per month; and 16% took more than 20 doses per month, Luetkemeyer said.

“We saw no serious or grade 2 or higher adverse events attributed to doxycycline and a majority of patients reported taking doxycycline as acceptable or very acceptable,” she said.

The researchers noted that available culture data from those who had gonorrhea infections during the study demonstrated a relatively low rate of 20% resistance to tetracycline – a proxy indicator of resistance to doxycycline – which which may partly explain the effectiveness of doxycycline/PEP in reducing gonorrhea infections. In this study.

“However, larger studies and population-based surveillance of those taking doxycycline/PEP are needed to understand whether doxycycline use could drop through the development of tetracycline resistance to gonorrhea” , said Luetkemeyer. “It is important to note that doxycycline is not used to treat active gonorrhea infections. Analyzes of the impact of intermittent doxycycline use on antibiotic resistance are ongoing.”

  • Ed Susman is a freelance medical writer based in Fort Pierce, Florida, USA.

Disclosures

Neither Luetkemeyer nor Lewin disclosed any relevant industry relationships.


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