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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 >


    ------------------------------
    Jonathan Pincus
    Codman Square Health Center
    Milton MA
    ------------------------------



  • 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)

    Plot 70667, Fairscape Precinct, Unit 1B, 3rd Floor, Fairgrounds

    P.O. Box 203258 Bontleng

    Gaborone, Botswana

    Tel: +267 3186101

    Fax +267 3186141

    M: +267 71578283....................

    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!



    ------------------------------
    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!

    ------------------------------
    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.

    ------------------------------
    Amber Siegel DNP AAHIVS
    Crew Healthcare
    Orlando, Florida
    ------------------------------



  • 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.

    ------------------------------
    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?

    ------------------------------
    Angela Kapalko
    Physician Assistant Chairperson for AAHIVM
    Philadelphia FIGHT CommunityHealth Centers
    Philadelphia PA
    akapalko@fight.org
    ------------------------------



  • 9.  RE: Prophylactic doxycycline for STIs?

    Posted 02-03-2022 16:42
    Edited by Hillary Liss 02-03-2022 16:43
    There is an ongoing DoxyPEP study at the ACTU at University of Washington!  It is not limited to UW patients.

    ------------------------------
    Hillary Liss
    University of Washington
    Seattle WA
    ------------------------------



  • 10.  RE: Prophylactic doxycycline for STIs?

    Posted 02-04-2022 10:29

    I think this is an important enough issue to reemphasize my point ...

     

    We, as a medical care entity, need to fundamentally change the way we think about the use of antimicrobials. The long term effects of excessive and unnecessary antibiotic use far outweigh the occasional short term benefits in situations such as the one described.

     

    Yes, in many many instances having an active antimicrobial circulating so that it encounters an organism on exposure will lead to prevention of an infection from that organism. What we are seeing time and time again is that resistance develops from this approach.

     

    Regards,

     

    David M. Bebinger, MD

     






  • 11.  RE: Prophylactic doxycycline for STIs?

    Posted 02-04-2022 18:14
    You raise an important point.  Living in a hotspot for both sexually transmitted and congenital syphilis (Palm Springs/Inland Empire) you also have to weigh the relative risks of ongoing syphilis outbreaks and the damage to adults & infants vs the possible risks.  That's why we need a well designed clinical trial to answer these questions, and to inform guidelines.  

    I'm encouraged to see the trial at UW Hillary references.  Perhaps she can share the clinicaltrials.gov or other link with info on the trial design, etc.

    Jeff





  • 12.  RE: Prophylactic doxycycline for STIs?

    Posted 02-04-2022 20:33
    This discussion demonstrates why we need vaccines for STIs. We have some (HPV, HAV, HBV) but need them for bacterial STIs. One for gonorrhea may be coming. I'm not sure if vaccines for chlamydia and for syphilis are being investigated. We may run out of antibiotics in the meantime. We've already lost most of the antibiotics for GC. I remember when we treated it with 2 grams of amoxicillin.
     
    Peter

    Peter Shalit, MD, PhD, FACP, AAHIVS 
    Cabrini Tower, 901 Boren Ave Suite 850, Seattle, WA 98104 
    P 206-624-0688 F 206-624-2432  





  • 13.  RE: Prophylactic doxycycline for STIs?

    Posted 02-05-2022 10:53
    Unfortunately these studies cannot demonstrate the resistance to the microbiome in any respectable fashion.
     
    David M. Bebinger, MD
     
     
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  • 14.  RE: Prophylactic doxycycline for STIs?

    Posted 02-02-2022 17:31
    This is great topic for ripe discussion. There is a lot of literature out exploring DoxyPrEP but there are no clear guidelines or recommendations. The major concerns have been what is the appropriate dose, dosing schedule, is is pre-exposure or post-exposure. I totally respect the concern for antimicrobial resistance, but there has been decades of use of daily doxycycline and there hasn't been any clinically significant evidence of resistance in C. trachomatis or T. pallidum., my concern would be increasing tetracycline resistant MRSA, but honesly how may of use are using doxycycline as first line for an MRSA infection. Below are some weblinks for reference. 

    https://www.croiconference.org/abstract/demand-post-exposure-prophylaxis-doxycycline-msm-enrolled-prep-trial/

    https://clinicaltrials.gov/ct2/show/NCT03709459 - Clinical trial in Australia, worth following for updates 

    https://academic.oup.com/cid/article/70/6/1247/5557867 2019 article in CID

    Overall I am not opposed to it and have discussed with a few patients I feel are good candidates.


    ------------------------------
    Quintin Robinson
    Absolute Care Medical Center & Pharmacy
    Atlanta GA
    ------------------------------



  • 15.  RE: Prophylactic doxycycline for STIs?

    Posted 02-03-2022 01:53
    See:
    1) Juliana S Grant, Chrysovalantis Stafylis, Connie Celum, Troy Grennan, Bridget Haire, John Kaldor, Anne F Luetkemeyer, John M Saunders, Jean-Michel Molina, Jeffrey D Klausner, Doxycycline Prophylaxis for Bacterial Sexually Transmitted Infections, Clinical Infectious Diseases, Volume 70, Issue 6, 15 March 2020, Pages 1247–1253, https://doi.org/10.1093/cid/ciz866
    --
    W. David Hardy, MD
    Scientific and Medical Consultant
    E-mail: wdavidhardymd@gmail.com
    Telephone:
    310-709-3505 (Mobile)





  • 16.  RE: Prophylactic doxycycline for STIs?

    Posted 02-03-2022 09:19
    I would use extreme caution with this approach noting the extreme uptake of antimicrobial resistance throughout the world. Taking an antimicrobial a day is sometimes necessary however it selects for drug resistant strains which predominate the patient's body and can lead to drug resistance in unusual species.
     
    Low dose antimicrobials are commonly used in livestock to promote weight gain which is often against patient goals.
     
    Please consider not doing this as a standard rule as it only falsely increases a perception of safety in an inherently vulnerable population.
     
    David M. Bebinger, MD
     
     
    The information transmitted is intended only for the person or entity to which it is addressed and may contain confidential and/or privileged material. Any review, transmission, re-transmission, dissemination or other use of, or taking of any action in reliance upon this information by persons or entities other than the intended recipient is prohibited. If you received this in error, please contact the sender and delete the material from any computer.