Post-exposure doxycycline prevents STIs in MSM, GWD with HIV or on PrEP | Latest news for doctors, nurses and pharmacists

Doxycycline, taken with 72 hours of unprotected sex, may prevent sexually transmitted infections (STIs) in men who have sex with men (MSM) or transgender women (TGW) who are living with HIV (PLHIV) or who are receiving pre-exposure prophylaxis (PrEP), according to a study presented at AIDS 2022.

“Doxycycline post-exposure prophylaxis [PEP] taken within 72 hours of condomless sex significantly reduced the incidence of bacterial STIs, with a quarterly reduction of 62% in PLHIV and 66% in those taking PrEP,” the author commented. study, Professor Annie Luetkemeyer of Zuckerberg San Francisco General Hospital, University of California. , San Francisco (UCSF), San Francisco, CA, USA.

The DoxyPEP open-label trial population included 501 MSM and TGW from Seattle, Washington, and San Francisco, CA, USA (median age 38, 67% white), who were either living with HIV or on PrEP . To be included, they had to have tested positive for early syphilis, Neisseria gonorrhoeae (N. gonorrhoeae), Where
Chlamydia trachomatis (C.trachomatis) of the previous year. They were randomized 2:1 to receive doxycycline hyclate (200 mg) or no doxycycline (standard of care only; control group) given within 72 hours of condomless sex. Participants were followed for 12 months. STI screening was performed at enrollment, quarterly, or when symptoms appeared.

A total of 327 participants were on PrEP (median age 36 years) and 174 were PLHIV (median age 43 years). Four percent identified as TGW or gender diverse. Participants had a median of nine sexual partners over the past 3 months. The most common STI experienced by participants in the past year was N. gonorrhoeae (69%), followed by
C.trachomatis and syphilis (58 and 20%, respectively).

Among those on PrEP, there was a significant 66% reduction each quarter in the incidence of new STIs among participants who received doxycycline compared to the control group (10.7% vs. 31.9%; risk reduction [RR]0.34, 95% confidence interval [CI], 0.24–0.46; p

The incidence of STIs was also significantly reduced by 62% in HIV-positive participants who received or did not receive doxycycline (11.8% versus 30.5%; RR, 0.38, 95% CI, 0.24 -0.60; p

The overall incidence of STIs was reduced each trimester with or without doxycycline (RR, 0.35, 95% CI, 0.27 to 0.46; p

Most STIs were asymptomatic. Participants who were on doxycycline tended to have fewer symptomatic STIs at diagnosis than those in the control group, in both the PrEP (15% versus 28%) and PLHIV (17% versus 24%) cohorts.

Doxycycline PEP was safe, acceptable and had high adherence rates, with 1.5% dropping out of treatment due to intolerance or preference, Luetkemeyer said. There were no grade reports
3 adverse events (AE), serious AE or grade 2 laboratory abnormalities.

Following an interim analysis scheduled for May 2022, the Data and Safety Monitoring Board recommended that enrollment be discontinued due to the significant efficacy of the intervention in both cohorts. They also recommended continuation of doxycycline treatment in the control group.

Practice-changing results?

“There is a worldwide epidemic of STIs [which] has a disproportionate impact on MSM and GWD, especially those living with HIV or taking HIV PrEP,” Luetkemeyer said.

“Based on these data, we believe that doxycycline PEP has the potential to be an effective prevention strategy in populations with a high incidence of STIs,” she concluded.

She highlighted the need for larger studies and continued surveillance among doxycycline PEP users to identify the impact of treatment on tetracycline resistance in gonorrhea.

“DoxyPEP represents a significant step forward in reducing STIs in two vulnerable populations – MSM and TGW,” commented Professor Sharon Lewin, IAS President-Elect and Director of the Peter Doherty Institute for Infection and Disease. Immunity, Melbourne, Australia, which was not affiliated with the trial. “I look forward to learning more about the implementation of this prevention measure and the long-term effects of using antibiotics for STI prevention,” she said.

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