Photo by Ketut Subiyanto from Pexels

Guidelines from The New York City Department of Health and Mental Hygiene to healthcare providers on the use of doxycycline (doxy-PEP) is being finalised to prevent some bacterial sexually-transmitted infections (STI), like syphilis.

The proposal creates a structure for a treatment that works in a similar method to the morning-after pill. However, it will work on STIs.

The guidelines concern, “cisgender men who have sex with men and transgender women with a recent history of these infections,” states a letter from 9 November by Celia Quinn (MD, MPH Deputy Commissioner Division of Disease Control) and Preeti Pathela (DrPH, MPH Executive Director, Sexually Transmitted Infections Program Bureau of Hepatitis, HIV, and Sexually Transmitted Infections).

The response of the health department comes as figures show an increase in rates of syphilis, chlamydia and gonorrhoea. The NYC Health Department wants to “ensure that” healthcare providers are “aware of the intervention” in prescribing doxy-PEP.

“Doxy-PEP for bacterial STI prevention consists of 200 mg of doxycycline taken ideally within 24 hours, but no later than 72 hours, after condomless oral, anal, or vaginal/front hole sex.”

According to the letter, studies have “demonstrated that doxy-PEP reduces the incidence of syphilis, chlamydia, and gonorrhoea among cisgender MSM and transgender women who have sex with men.”

The letter provides information on those eligible for doxy-PEP, dosing and prescribing guidance and the associated risks and benefits.

It does flag that the US Food and Drug Administration “has not approved” doxy-PEP for STI post-exposure and, at present, there is no US “national guidance for its use in STI prevention.”

However, the Centers for Disease Control and Prevention released proposed guidelines on 2 October 2023, that went through a 45 day public consultation period.

Once completed, the clinical guidelines will inform healthcare providers on how to use doxy-PEP to prevent bacterial STI infections. It is noted that, once finalised, work will continue to ascertain “the effectiveness of this approach for other populations, as well as potential long-term development of antimicrobial resistance and impacts on the microbiome.”

Read the letter in full here.