CURRENT EVIDENCE ON DOXYCYCLINE PROPHYLAXISĭoxycycline is a moderate-spectrum, second-generation tetracycline that is generally well tolerated. Findings are summarized using the Grading of Recommendations, Assessment, Development, and Evaluations framework specifically focusing on the quality of evidence and benefits versus harms. International public health and clinical experts from academia, government, and community-based organizations met on 3 March 2019 in Seattle, Washington, to frame the initial inquiry, which was then supplemented by focused literature searches to address specific questions of interest. This state-of-the-art review was conducted to examine the current state of research, knowledge gaps, and challenges around the use of doxycycline prophylaxis to prevent syphilis, caused by Treponema pallidum (TP), and other bacterial STIs such as Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG). However, the increasing adoption of HIV PrEP has shown that biomedical interventions for STI prevention can be effective, safe, and highly acceptable. While that trend started prior to the introduction of human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) in 2012, HIV PrEP has been associated with increases in sexual contacts and decreases in condom use with an resultant acceleration in the increase of bacterial STIs such as gonorrhea, syphilis, and chlamydia. Better and more robust data are needed on efficacy target population community acceptability behavioral risk compensation doxycycline dose, regimen, and formulation long-term safety antimicrobial resistance cost-effectiveness and risk–benefit.ĭoxycycline, prophylaxis, syphilis, chlamydia, men who have sex with menīacterial sexually transmitted infections (STIs) have been steadily increasing in gay, bisexual, and other men who have sex with men (MSM) over the past 2 decades. Doxycycline prophylaxis for bacterial STIs shows promise. Studies differed in design, population, outcomes, and safety measures. Five additional clinical studies are underway or in development. Two small short-term randomized controlled trials examining doxycycline prophylaxis found high efficacy. International academic and government experts met in March 2019 to frame the initial inquiry, which was supplemented by focused literature searches. We conducted a state-of-the-art review to examine the current state of research, knowledge gaps, and challenges around the use of doxycycline prophylaxis to prevent syphilis and other STIs. Doxycycline is used for primary prophylaxis in a number of infectious diseases. With the widespread use of early human immunodeficiency virus (HIV) treatment, which virtually eliminates transmission risk, and the availability of HIV pre-exposure prophylaxis, there have been attitudinal changes regarding HIV infection with resultant increases in sexual contact and declines in condom use. Bacterial sexually transmitted infections (STIs) have been increasing over the past 2 decades in gay, bisexual, and other men who have sex with men.
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