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DoxyPEP: A New Sexually Transmitted Disease (STD) Prevention Tool for Providers

CDC Releases DoxyPEP Guidelines

On June 6, 2024, the Centers for Disease Control and Prevention (CDC) published the CDC Clinical Guidelines on the Use of Doxycycline Post-Exposure Prophylaxis for Bacterial Sexually Transmitted Infection Prevention. 

The CDC's Dear Colleague Letter endorses DoxyPEP as the first new STD prevention tool in decades. DoxyPEP is the self-administration of 200 mg of doxycycline within 72 hours after sex to prevent bacterial STD acquisition.  

DoxyPEP has proven to reduce the risk of getting a bacterial STD for:

  • Gay, bisexual, and other men who have sex with men, and
  • Transgender women are at increased risk for infections. 

These infections are specific to syphilis, chlamydia, and gonorrhea.
 

DoxyPEP Efficacy and Considerations

The clinical guidelines incorporate the findings of several recent studies demonstrating that oral doxycycline after exposure can reduce the risk of contracting bacterial STDs, such as syphilis, gonorrhea, and chlamydia. DoxyPEP has shown to reduce syphilis and chlamydia by up to 70 percent and gonorrhea by up to 50 percent.

The guidelines also looked at the potential for antimicrobial resistance using DoxyPEP. Doxycycline has been safely used for decades and administered daily to treat conditions such as malaria, acne, and rosacea. Some studies noted some increased resistance to S. aureus. More research is needed to learn about possible significant effects on antimicrobial resistance and the body’s microbiome.
 

Doxy PEP Discussion with Clients

The CDC recommends healthcare providers discuss DoxyPEP with the following:

  • Gay, bisexual, and other men who have sex with men, and
  • Transgender women with a history of at least one bacterial STD (syphilis, chlamydia, or gonorrhea) in the last 12 months.

Consider DoxyPEP if these individuals plan to engage in sexual activities with an increased risk of an STD.

The current guidelines do not include recommendations for the following:

  • Cisgender women,
  • Cisgender heterosexual men,
  • Transgender men, or
  • Non-binary individuals assigned female at birth.

There is a lack of published studies to evaluate the efficacy of DoxyPEP. The CDC states that providers should use their clinical judgment and shared decision-making when discussing DoxyPEP with clients in these communities.
 

DoxyPEP Prescribing Guidance

Prescribe DoxyPEP in the context of a comprehensive sexual health exam. Sexual health care should include the following:

  • Risk reduction counseling,
  • STD screening and treatment every three to six months,
  • Recommended vaccinations, and
  • HIV testing with pre-exposure prophylaxis (PrEP) or care services, as appropriate.
  • Inform clients to seek care if they have STD symptoms or exposure.

Common side effects include:

  • Nausea,
  • Vomiting,
  • Diarrhea,
  • Heartburn,
  • Sun sensitivity, and
  • Rarely, esophageal irritation.

Explain to the client drug interactions (magnesium, calcium) and food interactions (dairy). Educate the client on other precautions and how to minimize side effects and interactions, such as:

  • Drink with a full glass of water,
  • Remain upright for 30 minutes after taking DoxyPEP,
  • Avoid taking magnesium or calcium supplements or dairy for two hours before or after DoxyPEP, and
  • Wear sunscreen.

Healthcare providers should prescribe self-administration of 200 mg of doxycycline (any formulation) as soon as possible after sex (ideally within 24 hours but up to 72 hours). DoxyPEP should not exceed a maximum dosage of 200 mg every 24 hours. Providers can prescribe up to a 90-day supply, with refills until the next follow-up visit.
 

Clinical Resources

Some of these resources were created before the publication of the CDC guidelines. Providers should tailor all clinical protocols and educational materials to fit the needs of their local communities while considering the most current CDC guidelines.

CDC

Health Resources and Services Administration (HRSA)

Denver STD Prevention Training Center DoxyPEP Services

National Coalition of STD Directors-DoxyPEP Command Center

San Francisco Department of Health

Seattle & King County Health Department

NYC Department of Health & NY State AIDS Institute

Podcasts and Webinar Recordings

 

HIV/STD Program

HIV/STD Program

Doxycycline for Post-Exposure Prophylaxis (DoxyPEP)

DSHS HIV/STD Program

DSHS HIV/STD Program

Email the HIV/STD Program
Call the HIV/STD Program
737-255-4300