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Doxycycline postexposure prophylaxis reduces syphilis and chlamydia infections by over 86% and 89%, respectively, with moderate protection against gonorrhea (54.7%).
Bacterial sexually transmitted infections (STIs) have surged in recent years, prompting the need for innovative prevention strategies. Doxycycline postexposure prophylaxis (DP) has emerged as a promising intervention, particularly for syphilis and chlamydia prevention. Clinical trials have demonstrated high DP efficiency in cisgender men who have sex with men and transgender women, but real-world data on its performance and prescribing patterns have remained limited—until now.
Hence, researchers analyzed electronic health records of 2,083 subjects prescribed DP between 2019 and June 2024. The study examined patient demographics, STI testing history, and DP usage patterns to determine its real-world effectiveness and impact on clinical practices. Over half of DP users were White, and nearly half (48.1%) were aged between 31 and 40 years old. Most patients had not been diagnosed with an STI in the prior year, though those having a history of STIs were more likely to begin DP early. DP use varied prominently among patients, affecting its effectiveness.
As found, DP demonstrated 86.4% competence in preventing syphilis and 89.7% competence against chlamydia, closely aligning with clinical trial results. DP failures for syphilis or chlamydia occurred only in those with low adherence, reinforcing the importance of consistent use. For gonorrhea, DP yielded moderate protection, curtailing infections by 54.7%. Effectiveness was similar regardless of the infection site, whether rectal, throat, or urine sample.
This study confirms that DP is a highly beneficial real-world strategy for STI prevention, with results mirroring those seen in controlled clinical trials. The findings underscore the importance of adherence to DP regimens and furnish critical insights into prescribing patterns that could shape future clinical guidelines. As bacterial STI rates continue to escalate, DP may play a fundamental role in public health efforts to curb infections, particularly among high-risk populations.
Open Forum Infectious Diseases
Doxycycline Postexposure Prophylaxis for Bacterial STIs: Prescribing Patterns, Use, Short-term Outcomes Among 2083 Patients in a Los Angeles Federally Qualified Health Care Program, and Implications for Widespread Use
Joseph Osmundson et al.
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