#398 Don’t Let It Burn: Doxycycline for post-exposure prophylaxis of sexually transmitted infections
CLINICAL QUESTION
Does post-exposure prophylaxis with doxycycline reduce the risk of developing bacterial sexually transmitted infections?
BOTTOM LINE
Single-dose doxycyline (200mg within 72 hours of condomless sex) reduces the risk of bacterial sexually transmitted infections from 36% with no prophylaxis to 23% at 9-14 months. Data is mainly limited to men who have sex with men, and a small number of transgender women; all taking HIV pre-exposure prophylaxis or living with HIV. Rates of chlamydia and syphilis are lowered but not gonorrhea.
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EVIDENCE
- Results statistically different unless indicated.
- One systematic review of all four recent randomized controlled trials (RCTs). 1727 participants, median age 24-43, 73% men who have sex with men, 1% transgender women, 26% cisgender women, all on HIV pre-exposure prophylaxis or living with HIV. 1 Single-dose doxycycline 200mg (within 72 hours of condomless sex) or no doxycycline. After 9-14 months:
- Any bacterial sexually transmitted infection (STI): 36% versus 23% (doxycycline), number needed to treat (NNT)=8.
- Chlamydia: 18% versus 7% (doxycycline), NNT=9.
- Syphilis: 9.8% versus 2.5% (doxycycline), NNT=14.
- Gonorrhea: Not statistically different.
- Participants took 4-7 doses/month.
- Stopping due to adverse effects: 2%-7% across RCTs.
- Cisgender women subgroup: No outcome statistically different.1
- Limitations: Only RCT in cisgender women performed in Kenya where 44% of women in the doxycycline group were possibly non-adherent with no evidence of doxycycline exposure in hair samples;1,2 all studies open-label.1,2
CONTEXT
- Sexual practices remained similar between groups (examples: Number of partners or number of condomless sex acts).3,4
- While development of isolates with antimicrobial resistance has been reported, clinical failures due to resistance were not reported in the RCTs of the systematic review above.5
- Guidelines recommend discussion of doxycycline post-exposure prophylaxis with all men who have sex with men and transgender women with a history of at least one bacterial STI (gonorrhea, chlamydia, and syphilis) in the last 12 months.6
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I am wondering if prophylaxis like this would help those with fewer partners and in heterosexual populations