Doxy-PEP Consensus Statement

Introduction Doxy-PEP involves taking 200mg of doxycycline up to 72 hours after a sexual act to reduce the risk of bacterial sexually transmitted infections (STI). Among gay, bisexual, and other men who have sex with men (GBMSM), clinical trials of Doxy-PEP have shown significant reductions in syphilis (by 70–80%) and chlamydia (by 70–90%), and to a lesser degree, gonorrhoea (ineffective in some trials, or 50–55% reduction in other trials, due to varying levels of tetracycline resistance in gonococcal isolates in different populations). However, uncertainty remains regarding unintended outcomes from Doxy-PEP. These may include harms to individuals taking Doxy-PEP, such as disruptions to their microbiome and increased antimicrobial resistance (AMR) in STIs and other organisms, and harms to the community through increased population-level AMR. As such, individuals who might benefit from Doxy-PEP need to be supported to weigh up the potential benefits versus the potential harms from using Doxy-PEP, while considering whether this STI prevention strategy is suitable for them in their current context, in addition to conventional STI prevention strategies such as condoms. Evidence for the effectiveness of Doxy-PEP, and considerations around potential risks of Doxy-PEP, are described in detail in ASHM’s previously published interim position statement. You can read the full consensus statement by visiting the Doxy-PEP Consensus Statement.