- 2024, Volume 82 - Number 1
- Published: March 6, 2024
Doxycycline prophylaxis for bacterial sexually transmitted infections: evaluating effectiveness, risks, and challenges
Filipe Monteiro 1, João Borges-da-Costa 2
1 Serviço de Dermatologia, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal; 2 Preventive Medicine, Dermatology and Venereology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
Filipe Monteiro, João Borges-da-Costa
La información completa de afiliaciones y autor de correspondencia está disponible en la versión original en PDF.
*Correspondence: Filipe Monteiro, Email not available
Abstract
The increase in sexually transmitted infections (STIs) in Europe and the USA, especially among men who have sex with men (MSM) and transgender women (TW), has raised concerns and prompted the exploration of doxycycline prophylaxis as a potential intervention. Doxycycline prophylaxis can be administered either as a daily 100 mg dose (DoxyPrEP) or a single 200 mg dose post-sexual activity (DoxyPEP). Recent clinical trials, primarily focusing on higher-risk groups, have shown reductions of approximately 70% in syphilis and chlamydia infections and conflicting results regarding gonorrhea infection (up to 50%). Despite these advancements, the effectiveness of doxycycline prophylaxis among women has not been established and this strategy raises concerns about community acceptability, adverse events, safety, antimicrobial resistance, microbiome disruption, and cost-effectiveness. Ongoing clinical trials and agent-based models aim to address these uncertainties to predict the impact on a population level and on specific groups. This review aims to assess the existing data of doxycycline STI prophylaxis, identify knowledge gaps, and synthesize existing literature and guidelines about the current recommendations.
