Might 8, 2023 — “Consider it as a morning after capsule, however for STIs,” was how Aniruddha Hazra, MD, put it. Hazra makes a speciality of infectious illness at College of Chicago Drugs Infectious Illness and International Well being unit.
The reason for the grand assertion? New analysis that reveals the antibiotic doxycycline reduces the onset of HIV and sexually transmitted infections (STIs) by two-thirds after publicity.
“So whereas a morning after capsule generally is a prophylaxis (or prevention) towards being pregnant, doxycycline can be utilized shortly after sexual contact, or potential publicity with an STI to stop acquisition of an an infection,” Hazra, who was not concerned within the examine, stated.
The brand new analysis from the Nationwide Institutes of Well being, aimed to floor earlier case research of doxycycline in a scientific trial of males who’ve intercourse with males, stated lead researcher Anne Luetkemeyer, MD, an infectious illness specialist with the College of California, San Francisco.
Earlier analysis from France in 2016 appeared to indicate that doxycycline – or doxy – labored towards sexually transmitted illnesses. However Luetkemeyer’s crew wished to substantiate these findings and examine its results in a distinct inhabitants, she stated.
This randomized, managed trial discovered doxycycline decreased incidence of sexually transmitted infections comparable to chlamydia and syphilis. Males assigned male at beginning demonstrated the advantages of the two-thirds price of prevention. A 2022 examine involving ladies in Kenya confirmed restricted to no prevention with doxycycline.
Doxycycline is an antibiotic within the tetracycline class. Like all antibiotics, it stops or slows bacterial infections however not viral ones. Doxycycline is used to deal with anthrax, malaria, zits, and different situations. A prescription for the antibiotic prices solely pennies if in case you have insurance coverage.
The analysis revealed in April within the New England Journal of Drugs reveals the broader utility of doxycycline in decreasing HIV and STIs in males who’ve intercourse males and in trans ladies.
The 2023 federally funded examine reveals that examine individuals, who reported having a sexually transmitted an infection prior to now 12 months, decreased their danger of renewed an infection by two-thirds with the safety of the antibiotic.
The examine, led by researchers on the College of California, San Francisco, and the College of Washington, enrolled about 500 adults from 4 clinic websites in San Francisco and Seattle. All of the examine individuals had been assigned male at beginning, reported sexual exercise, and had a historical past of STI or HIV analysis.
The trial discovered that 10.7% of sufferers who took doxycycline had a STI analysis in comparison with 31.9% of the management group — a two-thirds discount in STI instances. The HIV analysis for doxycycline sufferers was 11.8% vs. 30.5% within the management – once more a virtually two-thirds discount.
Regardless that there have been no stories of doxycycline-resistance within the chlamydia or syphilis instances, Luetkemeyer stated researchers are taking a look at strains of doxy-PrEP for individuals who have developed breakthrough infections to search for proof of resistance.
“We actually have to be vigilant about that chance,” Luetkemeyer stated. “However it simply has not been described but. And definitely, a number of syphilis and a number of chlamydia have been handled with doxycycline thus far.”
Trevor Hedberg, a doctor assistant and head of the Sexual and Reproductive Well being Stroll-In Clinic at Howard Brown Well being in Chicago, stated two sufferers have introduced up doxy as a pre-exposure therapy prior to now 6 months. He stated the clinic normally suggest doxycycline for folks assigned male at beginning who do intercourse work or who’ve had a syphilis diagnoses prior to now.
“So, you understand, the way in which I method the conversations round doxy PrEP relies on STI historical past,” Hedberg stated. “How the affected person perceives their danger of publicity to STI is, and going over the uncomfortable side effects and the security profile of doxycycline and whether or not it is one thing that they really feel comfy taking.”
Individuals have been extra accepting of utilizing doxy for pre-exposure safety over time, and the principle concern is on antibiotic resistance, stated Zach Hen, a well being educator at Middle on Halsted, a group heart devoted to the well being of LGBTQ+ folks within the Chicago space.
“I do see why there is a want for the analysis on doxy as a result of there’s been extra recorded instances of bacterial STIs going round and syphilis,” Hen stated.
At first, “lots of people had been shaming individuals who had been taking [doxy] PrEP to have the ability to entry extra intercourse. I do not actually see that occuring, at the very least locally that I serve,” Hen stated. “However the folks that I’ve heard from have extra of the like: You do not know if there’s going to construct a resistance, are we going to have tremendous gonorrhea or one thing over time.”
The discount of STI and HIV by way of doxycycline is usually relevant to those that are assigned male at beginning.
“I’d say that within the interim, till we have now extra info in cisgender ladies, that is not a inhabitants for whom doxy PrEP is beneficial,” Luetkemeyer stated. “I’d additionally say this actually is not an intervention for the overall inhabitants but.”
Hazra stated doxycycline is without doubt one of the most generally prescribed outpatient antibiotics inside the final 5 years after the ANRS analysis in France. Nonetheless, he suggested towards prescription for people who find themselves pregnant due to tetracycline’s potential danger of beginning defects together with discoloration of enamel and abnormality within the bones.
CDC has launched concerns of doxycycline prescription however not detailed steering. The San Francisco Division of Public Well being, the place Luetkemeyer practices, has launched suggestions for cisgender males and trans ladies.
Males who’ve intercourse with males are one group most in danger to be disproportionately impacted by HIV. In accordance with the CDC, the lifetime danger for HIV an infection amongst MSM is 1 in 6 in comparison with one in 524 for heterosexual males or one in 253 for heterosexual ladies.
“I feel [doxy PrEP] is a extremely good instrument within the toolbox for individuals who want extra STI prevention measures, and the way in which we take a look at it’s to attempt to provide this to people who find themselves carrying the very best danger,” Luetkemeyer stated.
