In Canada, gay, bisexual, and other men-who-have-sex-with-men (gbMSM) and trans women are disproportionately impacted by sexually-transmitted infections (STIs). Doxycycline post-exposure prophylaxis (DoxyPEP)—explained below—is a health promotion initiative aimed to reduce and prevent STIs in these populations. Please speak to your healthcare provider for further information about whether doxycycline is right for you.

What is doxycycline?

Doxycycline is an inexpensive antibiotic prescribed to treat acne, malaria, and bacterial STIs. Doxycycline belongs to a class of drugs known as tetracycline antibiotics. Recent research findings suggest that it can be taken before or after condomless sex to prevent certain bacterial STIs.

What is DoxyPEP?

When doxycycline is taken after condomless sex, it is known as ‘doxycycline post-exposure prophylaxis’ or ‘DoxyPEP’ to reduce the risk of getting STIs, such as gonorrhea, chlamydia, and syphilis. Think of it as a morning-after pill for STIs. DoxyPEP has been associated reducing the chance of getting an STI by 70 to 80%.

Did you know that an untreated STI can also increase the chances of transmitting or getting HIV? Preventing STIs with DoxyPEP and other safer sex practices can protect your health.

When should I take DoxyPEP?

You should take two 100 mg pills of doxycycline within 24 hours, but no later than 72 hours, after having condomless sex. This includes oral, anal, or vaginal/front-hole sex where a condom isn't used. If you have sex again within 24 hours of taking doxycycline, take your next dose 24 hours after your last dose. You can take doxycycline every day if you continue having sex without a condom, but make sure not to exceed 200 mg (two 100 mg pills) within a 24-hour period.

You can remember the “3-2-1 rule”: take within 3 days of sex, 2 tablets, no more than 1 dose per day.

How should I take DoxyPEP? What about side effects?

Doxycycline should be taken with plenty of water.
Remember to stay upright for at least 30 minutes after taking doxycycline (avoid lying down).
Doxycycline can be taken with food or without food, although taking with food may reduce the risk of gastrointestinal side effects, such as nausea.
Avoid taking doxycycline within 2 hours of having consumed dairy products, calcium, antacids, or multivitamins.
Doxycycline can make your skin more sensitive to the sun, so wearing sunscreen is recommended.

Is DoxyPEP right for you?

If you are a cisgender man or transgender woman, DoxyPEP is one way to reduce your risk of STIs without compromising your pleasure, even if you’re having sex without condoms!

DoxyPEP has the potential to benefit the health of gbMSM/trans women through STI prevention, lessened patient anxiety, and improved sexual health and well-being. The use of DoxyPEP for STI prevention should be a discussion between the patient and their healthcare provider, covering all of the benefits and potential unknowns, using shared decision-making, and consulting with STI experts as necessary.

At this time, there is no clear data supporting use of doxycycline for STI prevention in non-gbMSM/trans women populations, and no data in non-adult populations.

On PrEP or HIV medications? DoxyPEP can be used for people regardless of their HIV status. This means that the doxycycline does not interact with PrEP medications (that prevent HIV) or HIV treatment (which helps manage your HIV diagnosis).

What else do we want to know about DoxyPEP?

Recent studies have been focused on highly motivated gbMSM and transgender women (or gender diverse people). Studies of DoxyPEP need to be designed for other populations at high risk of STIs.
Will DoxyPEP increase doxycycline resistance in bacteria that cause STIs? Although doxycycline has been used for decades, there is not resistance to doxycycline in chlamydia or syphilis. About 25% of gonorrhea bugs in North America are already resistant to doxy; DoxyPEP may not work against these strains. Ongoing and new studies will help us understand whether using DoxyPEP changes antibiotic resistance in gonorrhea.
Further research is also required to have evidence if DoxyPEP affects our gut microbiome—or the balance of healthy/ normal bacteria—in the gastrointestinal tract.
Can I take doxycycline before I have sex to prevent bacterial STIs? We don’t yet know if taking doxycycline daily has any added benefit for preventing STIs like we do for HIV PrEP. Research studies are currently underway to determine if daily DoxyPrEP is effective at preventing bacterial STIs.

Despite the unanswered questions, DoxyPEP should not be withheld from gay, bisexual, men who have sex with men & trans women if it is expected to provide a clear benefit. All efforts should be made to make access to DoxyPEP as timely and as easy as possible. Speak with one of our healthcare professionals today!

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