A report back on Basil Donovan and Christopher Fairley's Debate: Doxycycline should be provided for syphilis prophylaxis in those at high risk. 

As the Sexual Health conference came to a close, it was time for some light-hearted debate between Basil Donovan and Kit Fairley on the use of doxycycline as syphilis prophylaxis. The session Chair, Lewis Marshall, introduced the debate as being akin to all good duels, such as that between David and Goliath or Buzz Lightyear and Woody! Hang on…. aren’t Buzz and Woody on the same team? And in fact, this was a good predictor of what was to come. Basil was tasked with the affirmative and set about laying the ground work for the potential to all but eliminate the syphilis epidemic in 10 years if we could convince about half of all men who have sex with more than 20 male partners a year to take daily prophylaxis. It is our moral obligation in fact to provide such chemoprophylaxis if one exists. Basil downplayed any potential for side effects and antimicrobial resistance (reassuring us that all the antimicrobial resistance to doxycycline has already occurred – hardly reassuring) and added in the benefit that we could also potentially prevent chlamydia and gonorrhoea. “The community want it”, Basil says and seeing as it works so well for HIV, chemoprophylaxis for syphilis is the logical next step. 

Kit was there to provide the negative. His argument wasn’t bad. He took us through the absurdity of the number of doses of doxycycline that would be required to be taken by an individual to prevent just one personal infection – a feat that would see their doctor in the grave before realising their goal. He played up the side effects and potential harms which included weight gain (well illustrated by the use of doxycycline to promote weight gain in poultry!).  But perhaps Kit’s argument was over before it even began. During the disclosure of interests, Kit pointed out that the opinions he was about to give, were not, in fact, his own. So indeed it really was a battle of Woody and Buzz. The Evil Emperor Zurg was nowhere to be seen. The final result….a draw.

Author bio: Sharon is the Clinical Nurse Consultant for HIV & Sexual Health at St George Hospital, Sydney, NSW.