BASHH welcomes publication of position statement on doxycycline as post-exposure prophylaxis for sexually transmitted infections

The British Association for Sexual Health and HIV (BASHH) has welcomed the publication of a new joint BASHH and Public Health England (PHE) position statement on the use of doxycycline as post-exposure prophylaxis (PEP) for sexually transmitted infections (STIs).

A report published in the 2017 Conference on Retroviruses and Opportunistic Infections (CROI) suggested that use of PEP with doxycycline was associated with a halving of the rates of bacterial STIs in men who have sex with men (MSM), in an extension of the French IPERGAY trial.

The study was the first randomized open-label trial of the efficacy and safety of a novel antibiotic prophylaxis strategy for STIs using doxycycline PEP (200 mg within 24h after sex) in 232 MSM on PrEP for HIV prevention in the Ipergay study.

Whilst the results from the study showed that doxycycline PEP can reduce the incidence of chlamydia and syphilis in this population, as outlined in the position statement, extreme caution is advised in the use of doxycycline in this way, as a result of unknowable risks associated with widespread, unprescribed and unmonitored use of a tetracycline antibiotic. Such a scenario would create significant potential to select resistance not just in STI pathogens, but in other bacterial species as well.

Use of doxycycline PEP for sexually STIs is not endorsed by BASHH or Public Health England and further studies are required to measure the wider impact of prophylactic doxycycline on AMR at an individual and population level. It is recommended that antibiotics are used as prescribed by a healthcare professional and as indicated by the results of a suitable diagnostic test.

The full position statement is available on the BASHH Guidelines website - Click Here