Illustration depicting a chlamydia-infected cell. Chlamydia trachomatis micro organism (represented by small darkish spherical shapes colorized blue) bear improvement inside a membrane-enclosed “inclusion body.” The darkish inexperienced form on the best of the cell denotes the nucleus. Credit score: NIAID
As well being care companies start providing doxycycline to stop bacterial sexually transmitted infections (STIs), real-world proof demonstrates that the postexposure technique, referred to as doxy PEP, is lowering the speed of syphilis and chlamydia, however has had little to no impact on gonorrhea and wishes shut monitoring for indicators of antibiotic resistance.
JAMA Inner Drugs has printed two stories of early outcomes of doxy PEP rollout in California. Encouraging indicators and remaining scientific questions from these stories are highlighted in an accompanying commentary by Jeanne Marrazzo, M.D., M.P.H., director of the Nationwide Institutes of Well being’s Nationwide Institute of Allergy and Infectious Ailments (NIAID), and Jodie Dionne, M.D., M.P.H., affiliate professor of drugs within the Division of Infectious Ailments and affiliate professor of obstetrics and gynecology within the Division of Maternal-Fetal Drugs on the College of Alabama at Birmingham.
“These reports are part of the crucial scientific process of translating clinical research to implementation at scale,” mentioned Dr. Marrazzo. “Doxy PEP is proving to be an important intervention in our effort to decrease STI incidence while we continue to invest in research to develop safe and effective preventive vaccines and next-generation antibiotics.”
The Facilities for Illness Management and Prevention (CDC) reported greater than 2.4 million instances of syphilis, gonorrhea, and chlamydia in the USA in 2023, together with 3,882 instances of congenital syphilis, of which 279 resulted in stillbirths and toddler deaths. Whereas the most recent information present indicators the STI epidemic is likely to be slowing, case counts are nonetheless 90% greater than 2004 ranges and current a risk to peoples’ well being.
Taking oral doxycycline inside 72 hours of condomless intercourse diminished the incidence of the bacterial STIs syphilis, chlamydia and gonorrhea by two-thirds amongst homosexual, bisexual, and different males who’ve intercourse with males and transgender girls in a current randomized managed trial. Nonetheless, the antibiotic had no preventive impact in an identical examine in cisgender girls. Based mostly on this proof, the CDC recommends that U.S. well being care suppliers talk about doxy PEP with males who’ve intercourse with males and transgender girls who’ve a historical past of at the least one bacterial STI.
In one of many new printed analyses, public well being surveillance information from chosen public clinics in San Francisco confirmed that instances of early syphilis and chlamydia in males who’ve intercourse with males and transgender girls decreased by 50% and 51%, respectively, after 13 months of focused doxy PEP implementation, however gonorrhea incidence elevated by 26% in the identical time interval.
Within the different evaluation, pharmacy prescription information from an built-in well being system in California confirmed that after 12 months of doxy PEP rollout in individuals assigned male intercourse at start who had been additionally taking HIV pre-exposure prophylaxis, STI positivity charges declined by 79%, 80%, and 12% for chlamydia, syphilis, and gonorrhea, respectively. The declines in gonorrhea had been restricted to infections on the urethra and rectum. No declines had been seen on the pharynx (throat), a typical website the place individuals purchase gonorrhea.
Of their commentary, Drs. Marrazzo and Dionne celebrated doxy PEP’s substantial impact on chlamydia and syphilis in routine well being service settings. They cautioned that the combined outcomes on gonorrhea, together with outcomes from one other current examine displaying individuals taking doxy PEP had some proof of resistance to a category of antibiotics for gonorrhea therapy, level to the necessity to carefully observe the event of antimicrobial resistance within the context of doxy PEP use and to incorporate measures of drug resistance in all doxy PEP research. In addition they famous some disparities in doxy PEP uptake and the necessity to guarantee equitable data, acceptability, and entry because the rollout continues.
Reflecting on ongoing analysis wants, Drs. Marrazzo and Dionne pointed to the persistent gaps in doxy PEP proof for cisgender girls. They referred to as for analysis to higher perceive the connection between doxycycline dosing frequency and its preventive efficacy in real-world settings, in addition to the sturdiness of doxy PEP’s protecting results.
Lastly, they highlighted broader STI intervention wants, together with secure and efficient vaccines and new antibiotics for all individuals affected by STIs.
Extra info:
Madeline Sankaran et al, Doxycycline Postexposure Prophylaxis and Sexually Transmitted An infection Developments, JAMA Inner Drugs (2025). DOI: 10.1001/jamainternmed.2024.7178
Commentary: Jeanne M. Marrazzo et al, DoxyPEP to Forestall Bacterial STIs—Prepared for Prime Time?, JAMA Inner Drugs (2025). DOI: 10.1001/jamainternmed.2024.7165
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As prevention technique for sexually transmitted infections rolls out, specialists spotlight each promise and data gaps (2025, January 7)
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