Doxy-PeP - The day after pill for bacterial STIs (it is under review by the CDC)

[Teevster]

Hey all. A few months ago I mentioned Doxy-PEP - which is a morning after pill against bacterial STIs (gono, chlam and syphilis). You basically take 2 pills (200 mg) of Doxycylin after sex (within 72 hours, but the sooner the better) and you can reduce the chance of catching a bacterial STI DRASTICALLY.

It seems that this treatment is now being reviewed by the CDC and is now becoming common knowledge.

Talk to your doctor about it.

-Teevster

 

[Lover]

Interesting idea! I see some pitfalls

A false sense of security. You can still catch viruses like HIV, HPV and herpes. And just as with condoms, it only reduces the risk of catching a bacterial STI, not eliminate. I think lots of people will miss this in the beginning

Personally, I have doubts this will be accepted all over the world. Antibiotic resistance may increase over time as the use of doxycycline increases for prophylactic purposes. And usually prophylactic treatment is for people with compromised immune systems. Will be interesting to see if the treatment becomes widely acknowledged!

Lastly, and I just looked this up after I wrote the things above: it seems that the CDC is only testing this treatment on men and transgender women having sex with men? Maybe in that case it will be accepted as these groups are a minority, and the resistance may develop much slower... but I have a hard time believing doctors will not prescribe it to a guy that has sex with lots of different women as well. He would be engaging in "risky sexual behavior" then

Public Comment Period for Doxy PEP Guidelines

STD Information from CDC. Facts, Statistics, Treatment, and Other Resources.

www.cdc.gov

 

[Teevster]

A false sense of security. You can still catch viruses like HIV, HPV and herpes. And just as with condoms, it only reduces the risk of catching a bacterial STI, not eliminate. I think lots of people will miss this in the beginning

This is a valid point. Most of the research performed on Doxy-Pep including high risk groups - basically individuals on PreP. PreP users get the hepatitis B vaccine. regarding herpes... yeah well condoms were never good in the first place anyway.

I think doxy-pep will be given on a case by case basis. I do not think doctors would prescribe doxy-pep to groups at high risk of HIV (and hepatitis, usually te same group) without offering them PreP and hep B vaccine.

Personally, I have doubts this will be accepted all over the world. Antibiotic resistance may increase over time as the use of doxycycline increases for prophylactic purposes

I talk with a specialist in infectious disease about exactly that: resistance. It was the first thing that popped in my mind "what about resistance?"

The answer I got was that:
1. By limiting the spread of gonohrea and syphilis, which have a higher prevalence in gays and bi-sexuals and transexuals, will usually be offered PreP and Doxy-PeP will be offered in that context. This entails that they will be forced into regular check ups (not forced, but pushed into testing if they want to keep their prescriptions). Currently the guideline is full STI-testing every 3 months. The idea here is to fight resistance by reducing the prevalence of gonorrhea and syphilis.
2. Doxycyline is also not routinely used for treating gonorrhea - unless I am mistaken, it is an injection of ceftriaxon. This is because of resistance and lack of efficiency against gono. So if Doxy is less efficient to treat gono, then perhaps there is a higher utility in using it as prophylaxy? I think this reasoning applies for syphilis too.
3. Heterosexuals in the west are mostly exposed to chlamydia. I doubt a doctor would prescribe doxy-pep to some chick who is scared of the chlam lol.

So that's the reasoning.

I am not in a position to judge whether epidemologically this makes sense. Just being the messenger.

Lastly, and I just looked this up after I wrote the things above: it seems that the CDC is only testing this treatment on men and transgender women having sex with men? Maybe in that case it will be accepted as these groups are a minority, and the resistance may develop much slower... but I have a hard time believing doctors will not prescribe it to a guy that has sex with lots of different women as well. He would be engaging in "risky sexual behavior" then

I think that this is correct, however, they do provide these "benefits" to straight people, you just got to come off as very sexual active and a bit freaky.

Just like PreP is not routinely given to heterosexuals (aside from female sex worker - who BTW I am sure will be offered Doxy-PeP) . However, it can be given on a case by case basis.

I was part of one of the Doxy-PeP trial and god do I miss my doxy!

Well gotta message my GP and tell him I have some rosacea that don't seem to get away.

Edit: you may also want to check this out.

-Teevster

 

[Lover]

3. Heterosexuals in the west are mostly exposed to chlamydia. I doubt a doctor would prescribe doxy-pep to some chick who is scared of the chlam lol.

Fun fact: When I had chlam, I was prescribed doxy for seven days. I wouldn't count out heterosexuals just yet

Doxycyline is also not routinely used for treating gonorrhea - unless I am mistaken, it is an injection of ceftriaxon. This is because of resistance and lack of efficiency against gono. So if Doxy is less efficient to treat gono, then perhaps there is a higher utility in using it as prophylaxy? I think this reasoning applies for syphilis too.

I don't think gono bacteria are resistant to doxycycline if they are going to use it for prophylactic treatment. Then people would get infected regardless, and it would be a bad idea.

I suppose it is less effective since they use ceftriaxon in the symptomatic stage (I just checked the national health agency here and it is the recommended option these days). But good thing doxy can be used in early stages

Very good post and points you raise. Thanks for sharing Teev

 

[Teevster]

Fun fact: When I had chlam, I was prescribed doxy for seven days. I wouldn't count out heterosexuals just yet

They give doxycylin to cure chlam because of increased resistance to azitromycin - which they prefere keeping around for chlamydia induced pneumonia or cases of LGV.

There has not to my knowledge been reported chlam resistance towards doxy. So if true no problem using doxy for PEP.

I doubt your chlam will be enough to convince an infectious disease specialist to prescribe doxy-pep

don't think gono bacteria are resistant to doxycycline if they are going to use it for prophylactic treatment. Then people would get infected regardless, and it would be a bad idea.

I suppose it is less effective since they use ceftriaxon in the symptomatic stage (I just checked the national health agency here and it is the recommended option these days). But good thing doxy can be used in early stages

Probably. Good point.

Also most strains of gono are not resistant. Considering doxy-pep works like 60-80% of the time leaves room to assume that the remaining 20-40% of Doxy-PEP failure could be attribute to certain forms of resistance.

That said, I am pretty sure it is most likely caused by patients not taking the meds as prescribed (there are many of those - I am in a PreP group on facebook and let me tell you how much stupid shit I read there of people using tenofovir/emtricitabine as PEP rather than PrEP - was also another dumbass who replaced his Truvada with valacyclovir - they were both antiviral according to him.... sometimes I do like the idea of doctors taking a bit of a paternalistic role....).