Using Doxy to Prevent STIs Warrants Caution

With drug-resistant sexually transmitted infections already on the rise, AHF warns prescribing antibiotic for post-exposure prophylaxis (PEP) could make matters much worse

As its “Gonorrhea Alert!” billboards still tower over 36 cities in 16 states across the nation, AIDS Healthcare Foundation (AHF), the world’s largest HIV/AIDS healthcare organization, is concerned the Centers for Disease Control and Prevention (CDC) reportedly plans to endorse a single dose of antibiotic doxycycline for post-exposure prophylaxis (PEP) to prevent the spread of sexually transmitted infections (STIs).

While an NIH-funded study found doxycycline reduces STI infections, the authors did report “a slight increase in antibacterial resistance” ^[1] which is consistent with previous studies about STI doxycycline treatment failures due to antibiotic resistance ^{[2, 3]}. About half of all gonorrhea infections are resistant to at least one antibiotic ^[4], and the CDC reports gonorrhea to be a “resistance of concern” when it comes to tetracycline (a class of broad-spectrum antibiotics that includes doxycycline, the antibiotic recommended for DoxyPEP) ^[5].

“We ignore the risk of rising antibiotic resistance at great peril to global public health,” said Michael Weinstein, AHF’s president and cofounder. “We already are facing perilous drug resistance for gonorrhea treatments. Condoms remain the most effective means of preventing STIs.”

References:

^[1] National Institutes of Health. (6 April 2023). NIH-funded study finds doxycycline reduces sexually transmitted infections by two-thirds. News Releases. Available online: https://www.nih.gov/news-events/news-releases/nih-funded-study-finds-doxycycline-reduces-sexually-transmitted-infections-two-thirds

^[2] Stamm LV. (2010). Global Challenge of Antibiotic-Resistant Treponema pallidum. Antimicrobial Agents and Chemotherapy, 54(2): 583-589. Available online: https://journals.asm.org/doi/full/10.1128/aac.01095-09

^[3] Grant JS et al. (2019). Doxycycline Prophylaxis for Bacterial Sexually Transmitted Infections. Clinical Infectious Diseases, 70(6): 1247-1253. Available online: https://academic.oup.com/cid/article/70/6/1247/5557867

^[4] Centers for Disease Control and Prevention. (23 December 2022). Combating the Threat of Antimicrobial-Resistant Gonorrhea. Available online: https://www.cdc.gov/std/gonorrhea/drug-resistant/carb.htm

^[5] Centers for Disease Control and Prevention. (2013). Antibiotic Resistance Threats in the United States, 2013. Available online: https://www.cdc.gov/drugresistance/pdf/ar-threats-2013-508.pdf

AIDS Healthcare Foundation (AHF), the largest global HIV and AIDS organization, provides medical care and/or services to more that 1.7 million individuals in 45 countries worldwide in the US, Africa, Latin America/Caribbean, the Asia/Pacific Region, and Eastern Europe. To learn more about AHF, please visit our website, find us on Facebook, follow us on IG and Twitter, or subscribe to our “AHFter Hours” podcast.

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We ignore the risk of rising antibiotic resistance at great peril to global public health. We are already facing perilous drug resistance for gonorrhea treatments. Condoms remain the most effective means of preventing STIs.