Exploring new recommendations for doxyPEP
You may have heard of doxyPEP, which stands for doxycycline post-exposure prophylaxis. It involves taking an antibiotic called doxycycline after having sex without a condom. This can help prevent certain bacterial sexually transmitted infections (STIs), such as chlamydia, syphilis and possibly gonorrhea. This prevention strategy is relatively new but has been gaining attention across the country as another way to help reduce high rates of STIs.
Although interest in using doxyPEP is growing, there is no global standard for its use. This prompted the Public Health Agency of Canada (PHAC) to publish recommendations that give health professionals evidence-based advice to support discussions about doxyPEP for STI prevention.
Recommendation 1: Health professionals may consider offering doxyPEP to cisgender gay, bisexual and other men who have sex with men (gbMSM) and transgender women at higher risk of bacterial STIs.
DoxyPEP can be considered as part of comprehensive STI services to help prevent syphilis, chlamydia and possibly gonorrhea. Health professionals and their patients should discuss the decision to use doxyPEP, making sure to consider the patient’s situation, values and preferences.
Research has shown that doxyPEP works very well to prevent syphilis and chlamydia among cis gbMSM and trans women. However, it is not as clear if doxyPEP is effective in preventing gonorrhea. As more research is conducted in other populations, PHAC will continue to review the evidence, and future recommendations may include guidance for other adults and adolescents who are not part of these communities.
Recommendation 2: Health professionals should discuss the risks of antibiotic resistance with their patients when deciding to use doxyPEP.
Antibiotic resistance happens when bacteria change after repeated exposure to antibiotics. These changes make antibiotics less effective or not effective at all. As a result, infections become harder to treat. We are still learning how doxyPEP affects antibiotic resistance. Using doxyPEP could lead to antibiotic resistance in bacterial STIs and other organisms. This means we might not be able to use doxycycline for bacterial STIs or possibly other infections.
In Canada, doxyPEP is not likely to work well or for long against gonorrhea. This is because gonorrhea already has resistance to doxycycline and using it more will increase this resistance. Using doxyPEP may cause bacteria to develop resistance to other antibiotics. This is an important concern for gonorrhea because there are already very few treatments that work for it.
Health professionals should explain these risks when helping patients decide whether they should use doxyPEP.
DoxyPEP as part of comprehensive STI prevention
DoxyPEP is one more tool in Canada’s toolbox of STI prevention strategies. Having multiple strategies helps ensure that the gaps left by one approach are covered by another. This helps create a more resilient and comprehensive response to STIs. While some strategies are universal, such as the consistent and correct use of barrier protection like condoms, others depend on different circumstances. For example, PHAC also recommends more frequent syphilis testing for people in groups with higher infection rates.
Ultimately, the new guidelines represent an important step forward. They give health professionals and communities a framework for using doxyPEP, along with considerations around benefits and risks. While it may not be the right choice for everyone, doxyPEP is another tool to help reduce bacterial STIs in Canada.
To learn more about doxyPEP and other STI prevention strategies, visit Canada.ca/STBBI and CATIE.ca.