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Prophylactic doxycycline for STIs?

  • 1.  Prophylactic doxycycline for STIs?

    Posted 04-06-2020 16:16

    Hello,

     

    Is anyone using doxycycline as prophylaxis for syphilis and CT? I have one gentleman this may benefit, but haven't yet taken the step.

     

    Your thoughts?

     

     

     

     

     

    Tiffany L. Townsend, MS, FNP-C, AAHIVS

    Pronouns: She/Her/Hers

    Maine Medical Center/Maine Medical Partners

    Gilman Clinic

    48 Gilman Street

    Portland ME 04102

    207.661.4400 (phone)

    207.662.6116 (fax)

     

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  • 2.  RE: Prophylactic doxycycline for STIs?

    Posted 04-07-2020 01:48
    We are not but there is some support and debate about it in the literature and there were two experts debating pros and cons at one of the STD meetings last year.

    Doxycycline Prophylaxis for Bacterial Sexually Transmitted Infections
    OUP Academic remove preview
    Doxycycline Prophylaxis for Bacterial Sexually Transmitted Infections
    Bacterial sexually transmitted infections (STIs) have been increasing over the past 2 decades in gay, bisexual, and other men who have sex with men. With the widespread use of early human immunodeficiency virus (HIV) treatment, which virtually eliminates transmission risk, and the availability of HIV pre-exposure prophylaxis, there have been attitudinal changes regarding HIV infection with resultant increases in sexual contact and declines in condom use.
    View this on OUP Academic >


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    Jonathan Pincus
    Codman Square Health Center
    Milton MA
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  • 3.  RE: Prophylactic doxycycline for STIs?

    Posted 04-07-2020 03:40
    How is it administered? How long?

    --
    Garegole Letang

    Training Lead

    Center for International Health, Education, and Biosecurity

    Maryland Global Initiatives Corporation

    Affiliate of the University of Maryland, Baltimore

    Botswana University of Maryland School of Medicine health initiatives (BUMMHI)

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    Skype: gc.letang





  • 4.  RE: Prophylactic doxycycline for STIs?

    Posted 02-01-2022 17:48

    ** BUMP **

    Hi all, I would really like to have a larger discussion on this subject!

    I feel ill prepared -- and, I have had a few patients.. well, wait, that's a lie - one patient -- who is currently on TDF/FTC for HIV PrEP, well tolerated, asking about qD proph with doxycycline.

    I'm in Philadelphia, and I have not yet connected with other HIV providers regarding the subject.

    I desire to see/study/review the studies and evidence. After a short brief scour, I saw UK and AUS studies. Knowing it's alt tx for Treponema, and 1st line for tx of C.t., I would like to know it's efficacy through prophylaxis. Any links, advice, and comments would be super helpful!



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    Ashwin Gupta
    Philadelphia PA
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  • 5.  RE: Prophylactic doxycycline for STIs?

    Posted 02-02-2022 06:55
    I love this topic, very juicy.  I've seen some data and I do have one patient who takes Doxy prescribed by his Derm for acne.  He has frequent known exposures but has not tested + for any STIs in years.  Also on PrEP.  It seems to me that most people worry more about antibiotic overuse/resistance than they do about preventing STIs.  Looking forward to others' comments!

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    Sophia Nurani
    New York NY
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  • 6.  RE: Prophylactic doxycycline for STIs?

    Posted 02-02-2022 21:05
    I personally took Doxycycline for years for rosacea but at a low dose.  Personally I would not prescribe it for prophylaxis. No way no how. It is widely prescribed for a plethora of bacterial infections. It is very effective in treating syphilis in patients who have a true allergy to Bicillin or adjunct to bicillin in HIV patients who are tx stubborn. It is successful at clearing a number of conditions:Such as a component to treatment for H.Pylori, post infective arthritis and skin abscess. Just to name a few. I personally would not burn my bridges with Doxy for prophylaxis.  That's just my take.

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    Amber Siegel DNP AAHIVS
    Crew Healthcare
    Orlando, Florida
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  • 7.  RE: Prophylactic doxycycline for STIs?

    Posted 02-02-2022 15:36
    There was a study presented a CROI several years ago - the last time CROI was in Seattle I believe. DoxyPrEP did well at preventing chlamydia and syphilis but had no effect on gonorrhea acquisition. I am wary to encourage more antibiotic resistance by having lots of sexually active people on daily doxycycline, because we are running out of treatments for STIs. I did agree to one patient doing "DoxyPEP" since his encounters are relatively infrequent and he is doing on-demand Truvada for PrEP. He is taking a couple days' worth of doxycycline after an encounter. I'm not aware of data for this though.

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    Peter Shalit
    Dr. Shalit's Office
    Seattle WA
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  • 8.  RE: Prophylactic doxycycline for STIs?

    Posted 02-02-2022 15:59
    I agree with Dr Shalit, antibiotic resistance is my biggest concern -- a few years ago, the Philadelphia Health department got the data out of Seattle and the health department head at the time, Dr Farley, went on a mission to get us all to prescribe doxyPrEP for HIV pos MSM who had a history of syphilis. I mean, big push. Like had a meeting with our office and everything. we MIGHT have 2-3 patients on in the whole practice but largely, it did not catch. I havent seen/heard of new data. Maybe CROI will have something this year other than COVID?

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