Could an antibiotic taken after unprotected sex prevent STIs? What to know about doxy-PEP.

Three boxes of capsules of doxycycline — If accredited, a brand new approach of administering the antibiotic doxycycline — known as doxy-PEP — might assist defend people who find themselves at excessive danger of STIs. (Picture credit score: Shutterstock)

The U.S. is at present dealing with a surge in sexually transmitted infections (STIs). To deal with that rise, medical doctors have raised the potential for prescribing some individuals an antibiotic to take after dangerous sexual encounters to stop such infections.

The drug routine, often called doxy-PEP, makes use of an previous antibiotic known as doxycycline and should scale back the chance of growing three main STIs — syphilis, gonorrhea and chlamydia — in people who find themselves at excessive danger of repeated an infection, proof suggests. The Facilities for Illness Management and Prevention (CDC) is at present evaluating these knowledge and is predicted to announce new steering this summer time. If that goes by way of, the FDA could broaden the record of how the doxycycline needs to be prescribed to incorporate post-exposure prophylaxis (PEP) in sure populations.

Here is what we all know to date about doxy-PEP, together with who it would work for and whether or not it might gas antibiotic resistance.

What’s doxy-PEP, and the way does it work?

Doxy-PEP will get its title from each its essential lively ingredient, the antibiotic doxycycline, and the kind of remedy, post-exposure prophylaxis (PEP).

Doxycycline belongs to a bunch of antibiotics often called tetracyclines, which inhibit the expansion of micro organism by stopping them from making important proteins. Doxycycline is a mainstay in treating bacterial infections reminiscent of pimples, urinary tract infections, eye infections and STIs. Usually taken as a pill a couple of times a day, doxycycline can begin to enhance a affected person’s signs inside two days.

PEP, in the meantime, is greatest identified to be used in human immunodeficiency virus (HIV). PEP includes taking a drug as quickly as attainable after a possible publicity to a pathogen to stop an infection.

Within the case of doxy-PEP, this may imply taking doxycycline inside three days of getting intercourse and not using a condom to cease the event of sure STIs. This is able to forestall bacterial development earlier than signs emerge, versus treating the signs afterward.

Molecule of doxycycline

Doxycycline is a tetracycline antibiotic, which implies it kills micro organism by stopping them from making proteins which are important for his or her development. (Picture credit score: Shutterstock)

How efficient is doxy-PEP?

To date, most analysis into doxy-PEP has been in males who’ve intercourse with males (MSM) and transgender ladies and has centered on stopping the unfold of gonorrhea, chlamydia and syphilis.

A 2018 examine in France, for instance, discovered that taking a single 200-milligram dose of doxy-PEP inside 24 hours after having condomless intercourse might scale back the chance of chlamydia and syphilis by round 70% in MSM. One other examine checked out homosexual and bisexual males, transgender ladies and nonbinary individuals assigned male at beginning who’d already been recognized with an STI. After they have been prescribed doxy-PEP for one 12 months after having an STI analysis, future infections dropped by greater than 40%.

In April, a examine printed in The New England Journal of Drugs (NEJM) additionally discovered that remedy with one 200-mg capsule of doxycycline inside 72 hours after condomless intercourse lowered the chance of recent STI infections by two-thirds in contrast with commonplace care in a trial of over 500 MSM and transgender ladies.

However the drug continues to be removed from being a one-size-fits-all resolution.

“Our examine doesn’t inform all people,” Dr. Annie Luetkemeyer, lead creator of the NEJM paper and a professor of drugs and infectious ailments on the College of California, San Francisco, instructed NPR. “It informs a bunch of people that already had an elevated danger of sexually transmitted infections.”

Furthermore, in cisgender ladies, a small examine didn’t discover a decrease charge of STIs with doxy-PEP, though trials are ongoing. As a result of antibiotics solely work in opposition to micro organism, doxy-PEP additionally can’t deal with HIV or different infections attributable to viruses, reminiscent of herpes or mpox.

Close-up of chlamydia bacteria

Most trials of doxy-PEP to date have centered on three widespread STIs: chlamydia (pictured above), syphilis and gonorrhea. (Picture credit score: Shutterstock)

What are the unintended effects of doxy-PEP?

In keeping with the CDC, potential unintended effects of doxycycline embrace phototoxicity, which means higher sensitivity to daylight, gastrointestinal signs and, in uncommon circumstances, the event of ulcers within the esophagus. Different attainable issues embrace a lack of urge for food, nausea and diarrhea.

Has doxy-PEP been accredited, and if that’s the case, who ought to take it?

Doxy-PEP continues to be at present categorised as “off-label” by the Meals and Drug Administration, which means preventive remedy for bacterial STIs will not be one of many listed makes use of on its approval label. (Docs can and continuously do prescribe medicines off-label for all types of causes.)

Nevertheless, the CDC is at present contemplating the mounting proof, together with the optimistic outcomes of the newest NEJM trial this 12 months, and is predicted to announce scientific steering for medical doctors and well being care suppliers this summer time. The FDA often follows the steering of the CDC on such issues.

“The proof may be very robust,” Dr. Leandro Mena, director of the CDC’s division of STD [sexually transmitted disease] prevention, instructed NPR. The brand new steering will possible give attention to teams which are at the next danger of repeatedly contracting STIs — particularly, MSM and transgender ladies.

Within the meantime, the CDC acknowledges that some persons are already utilizing doxy-PEP and, in response, has issued protecting interim steering. This contains being conscious of the goal populations studied in current trials, the dosage and the truth that different antibiotics shouldn’t be thought-about for PEP. (If somebody reveals signs of an STI and has had a current publicity, they need to get evaluated by a physician.)

May doxy-PEP worsen antibiotic resistance?

One danger of utilizing doxy-PEP is that it might worsen the “pressing public well being risk” of antibiotic resistance, wherein micro organism evolve such that antibiotics work much less successfully or not work in any respect in opposition to the germs.

Infectious-disease medical doctors are significantly fearful about Staphylococcus aureus micro organism, which usually dwell harmlessly within the nostril and pores and skin however could cause lethal infections in the event that they get into the blood, NPR reported. Certainly, within the NEJM trial, the prevalence of doxycycline-resistant S. aureus elevated by 8% amongst individuals taking doxy-PEP.

Equally, Neisseria gonorrhoeae, the species of micro organism that causes gonorrhea, can rapidly develop resistance to tetracyclines, the category of antibiotics that features doxycycline. Actually, 25% of circumstances of gonorrhea within the U.S. are already attributable to tetracycline-resistant micro organism.

Nevertheless, Luetkemeyer identified that individuals who get frequent STIs may even have to make use of antibiotics to clear them up.

“This is not a alternative between antibiotics and no antibiotics in males and transgender ladies with a historical past of recurrent STIs,” she mentioned in a press release. “The choice right here for a lot of is repeated STIs that result in recurrent antibiotics.”

Others are equally optimistic. Dr. Jeffrey Klausner, a professor of scientific inhabitants and public well being sciences on the College of Southern California, instructed Reside Science in an electronic mail that doxycycline is a “breakthrough in sexual well being” and gives a “new alternative for sexually lively adults to guard themselves from STIs” reminiscent of syphilis, chlamydia and gonorrhea.

This text is for informational functions solely and isn’t meant to supply medical recommendation

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