DoxyPEP Use Surges Despite No Official Recommendations

A recent online survey from the Netherlands reveals a worrying trend: informal use of doxycycline for STI prevention, known as doxyPEP and PrEP, is on the rise, even without official guidance from health authorities.

The survey, which involved 1,633 participants—predominantly men who have sex with men (MSM), alongside transgender and gender-diverse individuals—found that 22.5% reported ever using doxyPEP/PrEP, with 15% having used it recently. Alarmingly, 65% of respondents expressed intent to use doxyPEP/PrEP if it were to become formally available.

Inconclusive Guidance Leads to Rising Use

Conducted between February 26 and May 4 this year, the survey's analysis was published in Eurosurveillance. While doxyPEP has been shown to help prevent STIs like syphilis and chlamydia, guidelines are scarce, with only Australia, Germany, and the U.S. issuing recommendations. Just last January, Dutch health officials stated that doxyPEP/PrEP is not recommended.

One significant concern is the potential for increased antibiotic consumption, which could exacerbate the problem of antimicrobial resistance (AMR). Frequent use of doxycycline may disrupt the gut microbiome, leading to long-term health issues.

The Threat of Antibiotic Resistance

Recent research from Seattle, a pioneer in doxyPEP usage, found rising levels of antibiotic resistance among Neisseria gonorrhoeae and other bacteria in individuals who took doxyPEP. These findings underscore the threat to both individual and public health, necessitating diligent monitoring.

Spike in Informal Usage Since 2021

Compared to a similar survey in 2021, which reported only 2.5% of MSM participants had used doxyPEP, the recent data indicates a dramatic increase in informal use. Participants who used doxyPEP recently were typically more sexually active and perceived the drug as safe.

Notably, 29% of recent users identified their usage as doxyPrEP, which lacks clinical endorsement. Alarmingly, nearly 25% reported using other unapproved antibiotics like azithromycin and ciprofloxacin for STI prevention, often sourced from outside the Netherlands.

The Call for Guidelines and Monitoring

Survey authors stress the urgent need for established guidelines and monitoring systems to address misuse and the risks associated with AMR. They highlight that without formal oversight, the trend towards self-sourcing doxyPEP is likely to continue.

As peer influence plays a significant role in usage decisions, it’s crucial for health professionals to create accurate and culturally relevant communication strategies. This could empower individuals to make informed choices about their sexual health regardless of official recommendations.