Metro Weekly

The CDC’s Plan to Prevent STIs in Gay Men, Trans Women

Research suggests doxycycline, taken within 72 hours after condomless sex, may reduce the incidence of gonorrhea, chlamydia, and syphilis.

Doxycycline – Photo: Tim Proctor / Flickr

The U.S. Centers for Disease Control and Prevention issued a draft recommendation advising healthcare providers to consider prescribing a commonly used antibiotic to certain populations to prevent various sexually transmitted infections after engaging in condomless sex.

According to the draft recommendation, recent research indicates that prescribing the antibiotic doxycycline as a post-exposure prophylaxis within 72 hours after condomless sex may effectively reduce the risk of infections like chlamydia, gonorrhea, and syphilis.

The proposed guidelines recommend that the method of prevention, also known as doxyPEP, be prescribed to men who have sex with men and transgender women to prevent bacterial sexually transmitted infections.

“The proposed guidelines for bacterial STI prevention include post-exposure prophylaxis with doxycycline (doxycycline PEP) because it has demonstrated benefit in reducing chlamydia, gonorrhea, and syphilis infections and represents a new approach to addressing STI prevention in populations at increased risk for these infections,” the guidance reads.

The proposed recommendation does note, however, that doxyPEP should only be prescribed in the context of a “comprehensive sexual health approach” including risk-reduction counseling, STI screening and treatment, vaccination for some sexually transmitted infections, and linkage to pre-exposure prophylaxis (PrEP) to prevent transmission of HIV, for those who are HIV-negative, or treatment for those living with HIV.

The CDC notes that it will be seeking public comment on the proposed recommendation through November 16.

Dr. Jonathan Mermin, the director of CDC’s National Center for HIV, Viral Hepatitis, STD, and TB Prevention, told CNN in an email that public comment was needed because it “allows us to gather important input before finalizing guidance, and gives clinical providers, people affected by STIs, and partner organizations the opportunity to weigh in before our guidance is finalized.”

The CDC has not indicated when the new guidelines will be officially implemented. Until the CDC issues formal guidance on the use of doxyPEP, the drug will remain available as an “off-label” prescription for STI prevention. The U.S. Food and Drug Administration has not officially approved the medication for post-exposure prophylaxis, reports CNN.

According to a study published in the New England Journal of Medicine in April, doxyPEP was found to be 65% effective at reducing the incidents of gonorrhea, chlamydia, and syphilis at clinics in San Francisco and Seattle. 

The study examined 500 participants — all men who have sex with men or transgender women — over a nearly two-year period from August 2020 to May 2022. The participants — all of whom had a history of STIs in the past year — were randomly assigned to receive either doxyPEP or their usual standard of care without doxyPEP.

At the end of the study, researchers found that every three months, the combined incidence of gonorrhea, chlamydia, and syphilis was lower by about two-thirds among those treated with 200 milligrams of doxycycline — the standard dose used in doxyPEP — compared to the control group, provided they had taken the medication within 72 hours of engaging in condomless sex.

Researchers are hopeful that doxyPEP as a possible treatment could “mitigate the amount of antibiotics” that have to typically be used to clear up STIs after a person is diagnosed, Dr. Annie Luetkemeyer, one of the study’s co-authors, said at the time the results were released

Research on the drug’s effectiveness in other populations is limited. Still, doctors may soon recommend similar treatments to other groups, such as heterosexuals or women, if future research yields similar results.

Already, some local health departments have issued their own guidance recommending use of doxyPEP to prevent STIs. The San Francisco Department of Public Health endorsed the treatment in October. In April, the California Department of Public Health released guidance — similar to that proposed by the CDC — to healthcare providers treating men who have sex with men or transgender women who have had at least one bacterial STI in the past year. 

This development comes as the United States has seen an uptick in sexually transmitted infections following the end of COVID-19 era lockdowns. Based on CDC data, there was a 7% increase in STIs overall from 2020 to 2021, including a 5% increase in gonorrhea cases, and a 32% increase in syphilis infections. Chlamydia cases also rose by 4% from 2020 to 2021, but remained below pre-pandemic infection levels for 2017-2019.

Additionally, the emergence of a drug-resistant strain of gonorrhea has made some sexual health advocates cautious about recommending doxyPEP or other biomedical interventions, due to fears that emphasizing them over condoms may put sexual partners at higher risk of acquiring the incurable strain. 

Mermin, of the CDC, told The New York Post that doxyPEP could be the type of “game-changing innovation” needed to curb the STI epidemic — which is especially relevant now that the number of syphilis cases, for example, has reached its highest level in over 50 years.

“Considering multiple perspectives now — particularly from providers, members of communities heavily affected by STIs and prevention partners –will strengthen the quality and use of the first new STI prevention tool in decades,” Mermin said of the ongoing public comment period regarding CDC recommendations for doxyPEP.

But he also warned that access, outreach, and education that reaches at-risk or vulnerable communities will be necessary to successfully implement the strategy, noting: “No prevention tool — no matter how powerful — will change the STI epidemic if it doesn’t reach the people who need it most.”

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