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PREP,PEP, and DOXYPEP

DoxyPEP (Doxycycline)

"Good medicine or an illusion"

Doxycycline is an antibiotic that has been in use since the 1960s. It is also known as Vibramycin-D, Efracea, and Periostat. Doxycycline is a 'bacteriostatic' that inhibits the growth of bacteria but doesn't kill them directly. Amoxicillin (an antibiotic you may be more familiar with) is 'bactericidal' that directly kills the bacteria. It is available on the NHS to treat a wide range of bacterial infections such as chest infections and rosacea (skin condition).

Although prophylaxis (prevention) against STIs has a long history, dating back to the First World War, the two most important studies were the US DoxyPEP Study, conducted in San Francisco and Seattle, and the DOXYVAC study, conducted in Paris. Following promising trials in the USA and France, Doxycycline (or DoxyPEP) is also being touted as a preventative measure against STIs - a "morning-after pill" to prevent chlamydia, gonorrhoea and syphilis. However, it's not yet approved for use in the UK and it's unclear if/ when this will change anytime soon.

Public Health England (PHE) and the British Association for Sexual Health and HIV (BASHH) do not endorse the use of DoxyPEP. They say that the potential benefits of DoxyPEP are outweighed by the risk of developing antibiotic resistance in STIs and other bacteria.

Dissent on doxyPEP: recent guidelines becoming more cautious | NAM aidsmap | 24 Apr 2024
Two recent statements about taking the antibiotic doxycycline up to 72 hours after sex to prevent bacterial sexually transmitted infections, a prevention intervention known as doxyPEP, are notably more cautious about recommending its use than the first guidelines from California.

CDC to recommend antibiotic after sex for some to prevent STIs | CBS News | 4 Oct 2023 | 3m 51s
AIDS 2022: Antibiotics to prevent STIs | aidsmap | 1 Aug 2022 | 2m 13s

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