September 06, 2019
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Doxycycline prophylaxis promising for bacterial STI prevention

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Jeffrey D. Klausner, MD, MPH
Jeffrey D. Klausner

Findings from a state-of-the-art review showed that doxycycline prophylaxis may be a promising strategy to prevent bacterial STIs.

“The United States is currently experiencing the worst STD epidemic in more than a generation,” Jeffrey D. Klausner, MD, MPH, professor in the division of infectious diseases and department of epidemiology at the UCLA David Geffen School of Medicine and Fielding School of Public Health, told Infectious Disease News. “Rates of syphilis are among the highest in 25 years. We urgently need new approaches and strategies to control STDs. The use of doxycycline prophylaxis in core group members could be an important STD control strategy.”

Over the past 2 decades, the incidence of bacterial STIs among men who have sex with men (MSM) have been increasing, driven in part by widespread use of early HIV treatment and pre-exposure prophylaxis (PrEP) creating “attitudinal changes” regarding sexual contact and condom use, Klausner and colleagues wrote.

The aim of their review was to examine the current state of research, knowledge gaps and challenges associated with doxycycline prophylaxis for the prevention of STIs. The review found two small, short-term, randomized control trials that demonstrated high efficacy of doxycycline prophylaxis. Additionally, the researchers reported that five clinical studies are underway or in development to examine the efficacy and safety of doxycycline prophylaxis, and that the studies have different designs, populations, outcomes and safety measures.

According to the researchers, improved and more robust data are needed. They suggested focusing on efficacy; target populations; community acceptability; behavioral risk compensation; doxycycline dose, regimen and formulation; long-term safety; antimicrobial resistance; cost-effectiveness; and risk-benefit ratio.

“Doxycycline prophylaxis might be very effective at preventing syphilis and chlamydia in high-risk people,” Klausner said. “More research on the best way to use doxycycline — daily or as a single dose after sex; community acceptability; on its impact on the microbiome and antimicrobial resistance; and how to implement it as a STD control strategy [is needed].” – by Marley Ghizzone

Disclosures: The authors report no relevant financial disclosures.