Since COVID, sexually transmitted infections (STIs) have been rising in the U.S., especially in gay and transgender communities.
One approach to help reverse this trend is called “Doxy PEP.” We spoke with Dr. Stephen Fallon, Executive Director of Latinos Salud, South Florida’s leading HIV/STD community health clinic, to learn what the agency has planned to address this resurgence in STIs.
OutClique: There’s PrEP, and we’ve even heard of PEP. What’s Doxy PEP?
Doxy PEP is an antibiotic treatment that offers a chance to protect against bacterial STIs, even after the fact.
Latinos Salud has been closely monitoring the research on Doxy PEP. Some studies proved it can cut sexually transmitted infection rates in half, especially in urban gay communities. Other studies pointed to a possible risk, noting that if Doxy PEP was prescribed too broadly, people taking their doses inconsistently could accidentally build up and pass resistance to these very bacterial diseases in their communities.
For that reason, Latinos Salud has not yet promoted Doxy PEP publicly. We’ve been prescribing it to select patients who could otherwise have a high risk of acquiring and passing STIs along in the community.
But the surge in STIs calls for more people to know about Doxy PEP now. That’s why we announced our service in early April.
OutClique: Why should some people consider taking Doxy PEP?
Condoms protect against HIV, and also protect against most other STIs. PrEP protects against HIV, even if condoms are forgotten. But it doesn’t protect against STIs.
In the past 5 years, the number of people diagnosed with both HIV and another STI in South Florida has nearly doubled for syphilis (up 72%), chlamydia (up 97%) and gonorrhea (up 100%). Rates are also climbing significantly amongst HIV-negative community members.
OutClique: Who is Doxy PEP for?
Initial guidelines suggest that Doxy PEP is best used with gay or bisexual men, and transgender women, especially those who are either taking PrEP or who are HIV positive.
OutClique: How does Doxy PEP work?
Patients are prescribed the antibiotic doxycycline as soon as possible after experiencing condomless sex (ideally within 24 hours, definitely within 3 days).
OutClique: What do patients take? How difficult is it to take?
Doxy PEP is a very limited dose treatment. Patients take two 100 mg pills of doxycycline. If there’s another slip up, patients take another two pills.
Now, this is very important to understand: though PrEP, PEP, and Doxy PEP all sound similar, they have very different goals, and require very different levels of commitment from the patient.
PrEP is the daily pill to prevent HIV. People on PrEP make a commitment to take PrEP every day in advance of a possible slip up that could otherwise expose them to HIV. PrEP isn’t to be taken as a one-off or occasional medication. This is one exception to this daily commitment: PrEP is also available as a bi-monthly shot.
PEP, meanwhile, is like Doxy PEP in that the word “PEP” means “post exposure” (or, after the fact) prophylaxis (meaning something that protects). But the term PEP by itself refers to trying to keep HIV from latching on.
That’s a much tougher task than trying to stop a bacterial STI from reproducing. So, regular PEP to prevent HIV requires a serious commitment to 28 days of powerful anti-retroviral medications.
OutClique: How effective is Doxy PEP?
Three studies released at the Conference on Retroviruses and Opportunistic Infections (CROI) last month found Doxy PEP is highly effective in protecting against two STIs: chlamydia and syphilis. Unfortunately, it appears far less effective against gonorrhea, due to broad resistance to the type of antibiotic used in Doxy PEP.
OutClique: How can OutClique readers know if they should take Doxy PEP?
Latinos Salud’s clinical staff in each location will assess your fit for Doxy PEP, and prescribe it if you are a candidate. As a reminder, while Latinos Salud primarily advertises its services to the underserved gay Latino community, we’re here for everyone. You don’t have to be Latino to come to Latinos Salud.
Make an appointment for STD screening or for PrEP, and ask about Doxy PEP during your appointment.
Content Courtesy of OutClique Staff writer
