Part of the GBHSH community in Spain uses doxycycline to prevent sexually transmitted diseases

The increasing incidence of sexually transmitted bacterial infections (STIs) is a major public health problem worldwide. Therapies currently being investigated include the use of the antibiotic doxycycline as a method of post-exposure prophylaxis after unprotected sex – known as DoxyPEP.

Researchers have conducted the first study in Spain on the use of DoxyPEP as a prevention strategy in the Gay, Bisexual and Other Men Who Have Sex with Men (GBHSH) community in Spain.

“The results suggest that although medical and scientific associations rarely advocate the community use of DoxyPEP as a prevention strategy, the GBHSH community is already integrating it as a prevention measure,” explains Sergio Villanueva, who led the study and is a professor on the GBHSH faculty for Information and Audiovisual Media at the UB and researcher at the UB Center for Research in Information, Communication and Culture (CRICC).

The study, published in the journal infectionwas funded by Stop, an NGO dedicated to the sexual health of the GBHSH community of which Professor Villanueva is a member.

DoxyPEP, a promising tool but with the risk of increasing bacterial resistance

Several clinical research studies have been conducted recently – for example, the IPERGAY clinical trial in France in 2015; DoxyPEP in the United States or DoxyVac in France in 2022 – have studied the effectiveness of doxycycline as a method of post-exposure prophylaxis – known as DoxyPEP – with promising results against syphilis (Treponema pallidum), chlamydia (Chlamydia trachomatis) and, to a lesser extent, gonorrhea ( Neisseria gonorrhoeae).

Despite this evidence, most medical and scientific associations recommend against its use in the general population, primarily due to concerns about the potential impact of this therapy on growing antibiotic resistance.

The researchers say that “The European AIDS Clinical Society (EACS) advises that DoxyPEP can be suggested to people with recurrent sexually transmitted infections (STIs) living with the human immunodeficiency virus (HIV) and only on a case-by-case basis.”

“Following these recommendations, several national associations in European countries have issued similar guidelines, such as the Spanish Association of Infectious Diseases and Clinical Microbiology (SEIMC), which recommends DoxyPEP on a case-by-case basis.”

Data consistent with studies in other countries

In this context, the experts tried to get an overview of the distribution of this pharmacological tool in the GBHSH community. To this end, they surveyed 150 members of the community via the NGO’s social networks. The results showed that 35.4% of respondents had used doxycycline as DoxyPEP, of which 17.2% did not adhere to the dosing regimens identified in clinical trials – that is, 200 mg within 72 hours of sex without a condom.

Villanueva acknowledges that “these results are consistent with those observed in a similar study in Germany, where a comparable proportion of GBHSH community members surveyed had taken doxycycline in the past year and used it as DoxyPEP (35.4% vs 23%).”

As for the most common methods of taking doxycycline, according to the study, the most common are prescription from a specialist or using tablets left over from a previous treatment; in some cases they also get it by ordering it online or through unofficial channels.

In addition, the study also showed that past year use of DoxyPEP was associated with a decrease in the frequency of diagnosis of diseases such as syphilis and gonorrhea, but significant only for chlamydia.

However, the researchers emphasize that these results “should be interpreted with caution as they are based on self-reported data and crucial factors such as duration or adherence to DoxyPEP were not adequately captured in the survey.”

Need for regulations and guidelines for the safe use of DoxyPEP

In any case, according to the researchers, “a lack of regulation and decision-making can lead, on the one hand, to the misuse of doxycycline as a preventive strategy in drug regimens that are not based on solid evidence, and, on the other hand, to the acquisition of the drug through unregulated channels or through the distribution of false ones Information for healthcare professionals.

In this sense, the authors emphasize the need for “a medical and scientific discourse that, in collaboration with civil society organizations dedicated to sexual health, formulates systematic and evidence-based guidelines for this prevention tool, in order to guarantee the quality of treatments and training.” the professionals who prescribe them.”