Updated DoxyPEP Recommendations for STI Prevention
Quick facts
The National Advisory Committee on Sexually Transmitted and Blood-Borne Infections (NAC-STBBI) has released updated recommendations on the use of prophylactic doxycycline for the prevention of bacterial sexually transmitted infections (STIs), including chlamydia, syphilis, and possibly gonorrhea.
It is recommended to offer doxycycline post-exposure prophylaxis (DoxyPEP) (200 mg orally as a single dose, taken within 72 hours of exposure) to cisgender gay, bisexual, and other men who have sex with men (GBMSM) and transgender women (TGW) at increased risk of bacterial STI. Conditional recommendation, moderate certainty of evidence
It is also recommended to discuss personal, community, and population-level risks of antimicrobial resistance with individuals considering this intervention. Strong recommendation, moderate certainty of evidence
Key messages for healthcare providers
At this time, NAC-STBBI only has recommendations for DoxyPEP, not doxycycline pre-exposure prophylaxis (DoxyPrEP). Use of doxycycline as prophylaxis is an off-label indication.
Prescriptions can be given in advance for self-administration. Users are advised to take no more than 1 dose (200 mg) in a 24-hour period.
There is no consensus definition of “increased risk,” but examples of behaviours that may increase risk of bacterial STI include recent prior bacterial STI(s), 10 or more partners in the last 6 months, condomless sex with multiple partners, engaging in stimulant use during sex, and/or engaging in group sex.
The use of DoxyPEP should be reassessed every 3-6 months, as risk may change over time.
Given antimicrobial resistance concerns, when testing for gonorrhea, it is recommended to collect specimens for both culture and nucleic acid amplification testing (NAAT) in certain situations, per PHAC’s Gonorrhea Guide (external link).
To inform shared decision-making about DoxyPEP use, there are several topics that clinicians are advised to discuss with patients, per the NAC-STBBI Statement (external link) (Recommendation 2, Remarks).
