DoxyPEP
There’s a morning-after pill to prevent sexually transmitted infections!
What is DoxyPEP?
DoxyPEP means taking the antibiotic doxycycline after sex, to prevent getting an STI. 200mg (usually 2x100mg tablets) of doxycycline are taken ideally within 24 hours but no later than 72 hours after condomless oral or anal sex (research on vaginal sex is ongoing).
Research has shown efficacy against chlamydia was 88% and against syphilis 87% in HIV-negative people, and 77% and 74% in people with HIV. But efficacy against gonorrhoea was only 55% in people without HIV and 57% in people with HIV.
It is like a morning-after pill but for STIs. You can take doxycycline as often as every day when you are having condomless sex but don’t take more than 200 mg every 24 hours.
Research has shown efficacy against chlamydia was 88% and against syphilis 87% in HIV-negative people, and 77% and 74% in people with HIV. But efficacy against gonorrhoea was only 55% in people without HIV and 57% in people with HIV.
It is like a morning-after pill but for STIs. You can take doxycycline as often as every day when you are having condomless sex but don’t take more than 200 mg every 24 hours.
A strategy which has become popular, involves taking 2x100mg doxycycline tablets on Monday morning. This offers protection for any condomless sexual activity which took place over the weekend (Fri/Sat/Sun), while also minimising the amount of antibiotics taken.
How should I take DoxyPEP?
- Take doxycycline with plenty of water. If your stomach is upset by doxycycline, taking it with food may help.
- Some people are more sensitive to the sun when they take doxycycline, so wear sunscreen.
- Avoid dairy products, calcium, antacids, or multivitamins 2 hours before after taking doxycycline.
Doxycycline is approved for use in New Zealand, however its use for DoxyPEP would currently be 'off label' and at the discretion of prescribing provider.
Ask your primary care provider or sexual health care provider about DoxyPEP and if they can provide a prescription.
Doxycycline is approved for use in New Zealand, however its use for DoxyPEP would currently be 'off label' and at the discretion of prescribing provider.
Ask your primary care provider or sexual health care provider about DoxyPEP and if they can provide a prescription.
What are we still learning about DoxyPEP?
There are some questions around DoxyPEP and how this will effect drug resistance. There is no drug resistance to doxycycline within Chlamydia and Syphilis but there is some resistance within Gonorrhoea.
Research presented at CROI 2023 did not find markedly increased doxycycline resistance with little difference in resistance rates between people taking doxyPEP and not taking it but more research in the wider community is needed.
Research presented at CROI 2024 confirmedDoxyPEP's efficacy against chlamydia and syphilis in HIV-negative men was 88% and 87%, respectively (in HIV-positive men it was a bit lower), but against gonorrhoea it was only 55% effective.
Research presented at CROI 2023 did not find markedly increased doxycycline resistance with little difference in resistance rates between people taking doxyPEP and not taking it but more research in the wider community is needed.
Research presented at CROI 2024 confirmedDoxyPEP's efficacy against chlamydia and syphilis in HIV-negative men was 88% and 87%, respectively (in HIV-positive men it was a bit lower), but against gonorrhoea it was only 55% effective.
Useful Info & Links
In the USA, where the use of DoxyPEP has become fairly common among sexually active MSM, the CDC is currently working on clinical guidelines and have put these out for public comment.
The DoxyPEP Command Centre out of the US has some very good and helpful information.
In 2023 ASHM in Australia produced a consensus statement recommending the use of DoxyPEP for the prevention of syphilis amongst GBMSM where the risk/benefit calculation is most favourable. Regrettably New Zealand choose not to be part of this consensus statement and are instead working on their own version of it at the moment (no details on the progress of this have been released).
The DoxyPEP Command Centre out of the US has some very good and helpful information.
In 2023 ASHM in Australia produced a consensus statement recommending the use of DoxyPEP for the prevention of syphilis amongst GBMSM where the risk/benefit calculation is most favourable. Regrettably New Zealand choose not to be part of this consensus statement and are instead working on their own version of it at the moment (no details on the progress of this have been released).
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